The use of infliximab in patients with psoriasis is associated with an increased risk for serious infections compared with nonbiologic systemic therapies, according to the results of a prospective cohort study conducted in the United Kingdom and Ireland that used data from the British Association of Dermatologists Biologic Interventions Register (BADBIR). Results of the current analysis were published in the British Journal of Dermatology.

The investigators sought to compare the risk for serious infections linked with infliximab use in patients with chronic plaque psoriasis vs a cohort receiving nonbiologic systemic treatments.

Serious infections were considered those associated with hospitalization, the use of intravenous antimicrobial therapy, and/or that led to death.


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A total of 3843 participants were included in the evaluation through October 2016. Incidence rates of serious infections were significantly higher in the infliximab cohort (47.82 per 1000 person-years; 95% CI, 35.70-64.04) compared with those in the nonbiologic systemic cohort (14.18 per 1000 persons-years; 95% CI, 11.54-17.41) and those in the methotrexate-only cohort (11.98 per 1000 person-years; 95% CI, 8.82-16.27).

The use of infliximab was associated with an overall significant increase in the risk for serious infections compared with the use of nonbiologic therapies (adjusted hazard ratio [aHR] 1.95; 95% CI, 1.01-3.75; P =.046) and the use of methotrexate only (aHR 2.96; 95% CI, 1.58-5.57; P =.001). Moreover, infliximab therapy was linked with a significantly higher risk for serious infection in the first 6 months of treatment (aHR 3.49; 95% CI, 1.14-10.70; P <.029).

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The investigators concluded that the use of infliximab is associated with an overall 2-fold increase in the risk for serious infections compared with the use of nonbiologic systemic therapies. Thus, those individuals who meet the criteria for infliximab therapy should receive counseling regarding the risk for serious infection associated with use of the agent. These results, which are relevant to patients in the United Kingdom and Ireland, are also applicable in those countries that have similar eligibility criteria with respect to the prescription of infliximab.

Reference

Yiu ZZN, Ashcroft DM, Evans I, et al; BADBIR Study Group. Infliximab is associated with an increased risk of serious infection in patients with psoriasis in the United Kingdom and Republic of Ireland: results from the British Association of Dermatologists Biologic Interventions Register (BADBIR) [published online August 2, 2018]. Br J Dermatol. doi: 10.1111/bjd.17036