Infection Rates Similar for Biologic Agents vs Nonbiologic Agents in Children With Psoriasis

Risk for infection was not higher in pediatric patients with psoriasis treated with biologic agents compared with those treated with nonbiologic immunomudulators.

In children with psoriasis, infection risk does not vary significantly in those treated with biologic agents vs nonbiologic agents, according to study research published in the Journal of the American Academy of Dermatology. 

Th study included 57,323 treatment-naive children with psoriasis, whose data were retrieved from insurance claims. The rates of serious infections leading to hospitalization were compared in children initiating systemic biologic agents vs systemic nonbiologic agents, systemic biologic agents vs phototherapy, systemic nonbiologic agents vs phototherapy, and those with psoriasis vs those without. Risk ratios (RRs) were estimated using logistic regression to determine relative risk for each exposure pair before and after propensity score analysis with 1:1 nearest neighbor matching.

The 6-month RRs for serious bacterial infections before propensity score matching were 0.82 (95% CI, 0.20-3.42) for biologic agents vs nonbiologic agents, 3.78 (95% CI, 0.76-18.69) for biologic agents vs phototherapy, 4.63 (95% CI, 1.11-19.34) for nonbiologic agents vs phototherapy, and 1.98 (95% CI, 1.40-2.81) for children with vs without psoriasis. After propensity score matching, the RRs were 0.67 (95% CI, 0.11-3.98) for biologic agents vs nonbiologic agents, 1.50 (95% CI, 0.25-8.95) for biologic agents vs phototherapy, 5.00 (95% CI, 0.59-42.71) for nonbiologic agents vs phototherapy, and 1.84 (95% CI, 1.15-2.97) for children with vs without psoriasis. 

Limitations to this study include an inability to stratify by psoriasis severity using insurance claims data, a lack of categorization of specific dosing, a low number of serious infection endpoints, a lack of stratification by specific immunomodulating agents, and exclusive inclusion of treatment-naive children.

The study researchers concluded that children receiving treatment had a low risk for serious infections and that this risk was not higher in those patients using biologic agentsvs nonbiologic immunomodulators. Thesmall rate of serious infections reaffirms the safety of these treatment methods. However, clinicians “should remain mindful that [psoriasis], independent of treatment, might itself increase the risk [for] serious infections in pediatric patients.”

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Schneeweiss MC, Huang JT, Wyss R, Schneeweiss S, Merola JF. Serious infection risk in children with psoriasis on systemic treatment: a propensity score matched population-based study [published online March 3, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.02.065