Serious infection risk in children with psoriasis on systemic treatment: A propensity score-matched population-based study - 18/04/20
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. |
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Funding sources: This study was supported by the Brigham and Women's Hospital Department of Dermatology. |
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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. |
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IRB approval status: The Brigham and Women's Hospital Institutional Review Board approved this study (#2011p002580). |
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Reprints not available from the authors. |
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