Among individuals with moderate-to-severe psoriasis, new users of infliximab and adalimumab have an increased risk for serious infections compared with etanercept, while risks are lower with ustekinumab, according to a study published online July 21 in JAMA Dermatology.

Laetitia Penso, from L'Agence Nationale de Sécurité du Médicament et des Produits de Santé-Caisse Nationale de l'Assurance Maladie in Paris, and colleagues used data from the National Health Data System covering about 99 percent of the French population to examine the risk for serious infection for new users of biologic agents or apremilast compared to etanercept used to treat psoriasis.

Data were included for 44,239 new users of biologic treatment, with a median follow-up of 12 months. The researchers recorded a total of 1,656 serious infections, with an overall crude incidence rate of 25.0 per 1,000 person-years. Gastrointestinal infections were the most frequent serious infections (38.9 percent). The risk for serious infections was higher for new users of adalimumab or infliximab compared with etanercept after adjustment for time-dependent covariables (weighted hazard ratios, 1.22 and 1.79, respectively); ustekinumab correlated with a lower risk for having a serious infection (weighted hazard ratio, 0.79). For new users of interleukin-17 inhibitors and the interleukin-23 inhibitor guselkumab or apremilast, the risk for serious infections was not increased compared with etanercept. Concomitant nonsteroidal anti-inflammatory drugs or systemic corticosteroid use correlated with an increased risk for serious infections.

"These results could help physicians choose a biologic for patients with psoriasis who are at risk of serious infections," the authors write. "Other observational studies are needed to confirm results for the most recent drugs."

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