S'abonner

Serious infection risk in children with psoriasis on systemic treatment: A propensity score-matched population-based study - 18/04/20

Doi : 10.1016/j.jaad.2020.02.065 
Maria C. Schneeweiss, MD a, b, c, , Jennifer T. Huang, MD c, d, Richard Wyss, PhD b, c, Sebastian Schneeweiss, MD, ScD b, c, Joseph F. Merola, MD, MMSc a, c, e
a Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts 
b Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 
c Harvard Medical School, Boston, Massachusetts 
d Dermatology Program, Boston Children's Hospital, Boston, Massachusetts 
e Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 

Correspondence to: Maria C. Schneeweiss, MD, Division of Pharmacoepidemiology, Department of Medicine and Department of Dermatology, Brigham and Women's Hospital, 1 Brigham Circle, Suite 3030, Boston, MA 02120.Division of PharmacoepidemiologyDepartment of Medicine and Department of DermatologyBrigham and Women's Hospital1 Brigham Circle, Suite 3030BostonMA02120
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 18 April 2020

Abstract

Background

Psoriasis is increasingly treated with systemic medications, yet their safety is not well characterized in children.

Objective

We sought to estimate the 6-month risk of serious infections in children with psoriasis treated with biologics, systemic nonbiologics, and phototherapy.

Methods

Using insurance claims data, we identified children aged <18 years with psoriasis and compared the frequency of serious infections in those initiating biologics, systemic nonbiologics, and phototherapy. Relative risks were estimated before and after 1:1 propensity score matching.

Results

Among 57,323 children with psoriasis, the 6-month risk of infection was 4.2 per 1000 patient-years in 722 biologic initiators, 5.1 in 988 systemic nonbiologic initiators, and 1.1 in 2657 phototherapy initiators. The relative risk (95% confidence interval) of infection in biologics vs nonbiologics was 0.67 (0.11-3.98), in biologics vs phototherapy was 1.50 (0.25-8.95), and in nonbiologics vs phototherapy was 5.00 (0.59-42.71). The background risk of infection in children with psoriasis was 1 per 1000, almost double the risk compared with children without psoriasis (relative risk, 1.84; 95% confidence interval, 1.15-1.97).

Conclusions

We found no meaningful difference in infection risk between biologics vs nonbiologics and no robust difference between systemic users vs phototherapy. Independent of treatment, children with psoriasis had a higher risk of infection than those without psoriasis.

Le texte complet de cet article est disponible en PDF.

Key words : epidemiology, immunomodulating drugs, opportunistic infections, pediatrics, psoriasis, safety, serious bacterial infections, systemic medications

Abbreviations used : CI, ICD-9, ICD-10, PS, US


Plan


 Supplemental material: 1.
 Funding sources: This study was supported by the Brigham and Women's Hospital Department of Dermatology.
 Conflicts of interest: Dr S. Schneeweiss is the principal investigator of investigator-initiated grants to the Brigham and Women's Hospital from Bayer, Vertex, and Boehringer Ingelheim unrelated to the topic of this study, and was a consultant to WHISCON and is a consultant to Aetion, a software manufacturer of which he owns equity. His interests were declared, reviewed, and approved by the Brigham and Women's Hospital and Partners HealthCare System in accordance with their institutional compliance policies. Dr Merola served as a consultant and/or investigator for Biogen IDEC, AbbVie, Amgen, Eli Lilly, Novartis, Pfizer, Janssen, UCB, Celgene, Sanofi Regeneron, Merck, and GSK. Drs M. Schneeweiss, Huang, and Wyss have no conflicts of interest to declare.
 IRB approval status: The Brigham and Women's Hospital Institutional Review Board approved this study (#2011p002580).
 Reprints not available from the authors.


© 2020  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.


Tout le contenu de ce site: Copyright © 2024 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.