The use of cyclosporine, infliximab, and anti-IL17 agents may increase the risk for symptomatic urinary tract infection (UTI) in women with psoriasis, according to research published in the Journal of the American Academy of Dermatology.  

Investigators abstracted data from Biobadaderm, a multicenter prospective cohort of patients receiving biologic drugs for psoriasis. Patient data collected between 2008 and 2018 at 16 participating hospitals in Spain were used in analyses. Bacterial UTI cases were classified as afebrile and febrile for subgroup analyses. Adjusted rate ratios (aRR) were obtained for each psoriasis drug using a multilevel model, which incorporated demographic and clinical factors. The rates of UTIs in patients undergoing systemic therapy were compared with the rates among patients receiving methotrexate (MTX). Patients receiving combination therapy were excluded.

A total of 3013 patients were included in analyses, providing 9585 patient-years of follow-up. Among patients exposed to biologics, 91 UTIs were reported, 5% of which were considered serious. In patients receiving MTX, 19 UTIs were reported, 16% of which were considered serious. Compared with patients receiving MTX, the overall risk for UTI among patients receiving biologics was not significantly elevated (aRR, 1.01; 95% CI, 0.74-1.39).

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Subgroup analyses revealed significantly increased risk for UTI among women receiving cyclosporine (aRR, 5.08; 95% CI, 2.40-10.79), infliximab (aRR, 5.51; 95% CI, 1.08-28.22), and anti-IL17 agents (aRR, 3.65; 95% CI, 1.44-9.29). Cyclosporine and infliximab were associated with increased risk for afebrile UTIs only; anti-IL17 agents were associated with increased risk for both afebrile and febrile UTIs. A slightly decreased risk for UTI was associated with acitretin use in women (aRR, 0.35; 95% CI, 0.12-0.98).

These data suggest an increased risk for UTI among women receiving certain biologic drugs for psoriasis. Further study in a larger cohort is necessary to confirm these findings and to develop an appropriate screening strategy for high-risk patients.

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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Sahuquillo-Torralba A, Carretero G, Rivera R, et al; Biobadaderm Study Group. The risk of urinary tract infections in patients with psoriasis on systemic medications in Biobadaderm registry: a prospective cohort study [published online July 12, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.07.028