According to the results of an observational cohort study, the risk of serious infection may vary significantly among systemic therapies used in the treatment of psoriasis.
In order to better understand the risk of serious infection in psoriasis patients treated with systemic agents, the study authors analyzed prescription claims data obtained from the Optum Clinformatics Data Mart and Truven MarketScan databases between January 1, 2003 and September 30, 2015. Psoriasis patients that were new users of acitretin, adalimumab, apremilast, etanercept, infliximab, methotrexate, and ustekinumab were included in the study; the primary endpoint was serious infection requiring hospitalization.
“Cox proportional hazards regression was used to compare rates of serious infection for each exposure (acitretin, adalimumab, apremilast, etanercept, infliximab, and ustekinumab) with the referent group (methotrexate),” the study authors explained, adding, “We used pairwise 1:1 propensity score (PS) matching to adjust for potential confounders, which were assessed during a 180-day baseline period prior to study drug initiation.” Fixed-effects analysis was used to pool results from the 2 databases.
The study authors identified a total of 31,595 new users from the Optum database and 76,112 new users from the Truven MarketScan database. Compared with patients using adalimumab, etanercept, and ustekinumab, those who received acitretin, apremilast, infliximab, and methotrexate were found to be older and also had greater baseline comorbidity scores.
Results showed that the rate of overall serious infection was lower in patients on apremilast (HR: 0.50; 95% CI: 0.26, 0.94), etanercept (HR: 0.75; 95% CI: 0.61, 0.93), and ustekinumab (HR: 0.65; 95% CI: 0.47, 0.89) compared with those taking methotrexate. Additionally, when compared with methotrexate, the rate of overall serious infection did not differ among patients taking acitretin, adalimumab, and infliximab.
A review of data by infection type, showed that the risk of cellulitis (the most common type of serious infection) was found to be greater among acitretin users vs methotrexate users (PS-adjusted HR, 1.76; 95% CI, 1.11-2.80).
“This information should be considered when prescribing therapies for individual patients, as well as future treatment algorithms,” the study authors concluded.
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