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Journal of the American Academy of Dermatology
Volume 77, n° 5
pages 838-844 (novembre 2017)
Doi : 10.1016/j.jaad.2017.07.047
accepted : 30 July 2017
Original Articles

Serious infections among a large cohort of subjects with systemically treated psoriasis
 

Allison S. Dobry, MD a, b, Charles P. Quesenberry, PhD c, G. Thomas Ray, MBA c, Jamie L. Geier, PhD d, Maryam M. Asgari, MD, MPH a, b, c,
a Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts 
b Department of Population Medicine, Harvard Medical School, Boston, Massachusetts 
c Division of Research, Kaiser Permanente Northern California, Oakland, California 
d Pfizer Inc, New York, New York 

Correspondence to: Maryam M. Asgari, MD, MPH, Department of Dermatology, Massachusetts General Hospital, 50 Staniford St, Suite 270, Boston, MA 02114.Department of DermatologyMassachusetts General Hospital50 Staniford St, Suite 270BostonMA02114
Abstract
Background

Biologic therapy is effective for treatment of moderate-to-severe psoriasis but may be associated with an increased risk for serious infection.

Objective

To estimate the serious infection rate among patients with psoriasis treated with biologic as compared with nonbiologic systemic agents within a community-based health care delivery setting.

Methods

We identified 5889 adult Kaiser Permanente Northern California health plan members with psoriasis who had ever been treated with systemic therapies and calculated the incidence rates and 95% confidence intervals (CIs) for serious infections over 29,717 person-years of follow-up. Adjusted hazard ratios (aHRs) were calculated using Cox regression.

Results

Adjusting for age, sex, race or ethnicity, and comorbidities revealed a significantly increased risk for overall serious infection among patients treated with biologics as compared with those treated with nonbiologics (aHR, 1.31; 95% CI, 1.02-1.68). More specifically, there was a significantly elevated risk for skin and soft tissue infection (aHR, 1.75; 95% CI, 1.19-2.56) and meningitis (aHR, 9.22; 95% CI, 1.77-48.10) during periods of active biologic use.

Limitations

Risk associated with individual drugs was not examined.

Conclusion

We found an increased rate of skin and soft tissue infections among patients with psoriasis treated with biologic agents. There also was a signal suggesting increased risk for meningitis. Clinicians should be aware of these potential adverse events when prescribing biologic agents.

The full text of this article is available in PDF format.

Key words : biologics, epidemiology, psoriasis, serious adverse infections, soft tissue infections, TNF-α

Abbreviations used : aHRs, CI, IL, IR, KPNC, SSTI, TNF-α



 Supported by Pfizer Inc and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant K24 AR069760 to MA).
 Disclosure: In addition to research support from Pfizer Inc, Dr Asgari and Dr Quesenberry have received research support from Valeant Pharmaceuticals and Mr Ray has received research support from Merck & Co, Genentech, and Purdue Pharma. Dr Geier is an employee of Pfizer, Inc. Dr Dobry has no conflicts of interest to declare.
 Reprints not available from the authors.



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