Past infections, not psoriasis drugs, may be the biggest predictor of future infection risk: BADBIR study
British Association of Dermatologists Biologic Interventions Register (BADBIR) found prior serious infections may outweigh psoriasis drug choice in predicting future infection risk highlighting patient history as a key safety factor.
Researchers at the British Association of Dermatologists Biologic Interventions Register (BADBIR) have found that long term treatment with a majority of systemic therapies for psoriasis do not seem to significantly increase the risk of serious infections providing reassurance for patients using such drugs This large real-world cohort study which is published in the European Medical Journal (EMJ) aimed to gain a deeper insight into the impact of biologics and other systemic treatments on risk of infection by evaluating the data of 46,770 treatments in 18,976 adults with psoriasis.
Method of the study
The study showed systemic treatments are usually used for moderate to severe psoriasis which work to help decrease inflammation throughout the body by attacking the immune system. These drugs have an effect on the immune system and have a long history of concerns about increasing a patient's risk of infection. In the study patients were followed from initiation of treatment through death, therapy discontinuation or last follow-up including infections during therapy and in the first 90 days after banning therapy.
Serious infections were classified as those that needed hospitalisation, intravenous antimicrobial treatment or death. The majority of the study population was 57.4 per cent male with a mean age of 45.6 years and a body mass index (BMI) of 31.6 kg/m . The number of serious infections reported for the study period was 27.67 per 1,000 person-years. Patients who had serious infections showed increased risk of having another infection and in this cohort 78.70 serious infections were recorded for every 1,000 person-years of study.
What study found?
With statistical analysis researchers found a potential increased risk for serious infections in apremilast and secukinumab compared to adalimumab. The researchers noted however that the relationship was not always held true in sensitivity analyses indicating a lack of confidence in the relationship.
To further support the findings a recurrent event analysis was performed on the Prentice-Williams-Peterson model accounting for multiple events of infection for the same patient over time. This analysis found that the use of risankizumab was significantly associated with a reduced risk of serious infections compared with other treatments, such as brodalumab, etanercept and conventional systemic treatments. What is more concerning about these findings is that death attributable to serious infections was infrequent during the study period (1.81/1,000 PY).
What is psoriasis?
Psoriasis is a chronic autoimmune disorder that triggers an unusually rapid growth of skin cells that leads to thick, inflamed and scaly patches on the skin. The National Psoriasis Foundation (NPF) reports that the skin disease is often found on the knees, lower back, elbows and scalp. Psoriasis can cause skin lesions that are red and covered in white scales, itchiness, burning, dry skin and nail changes. Some common triggers are stress, infections, smoking, skin injuries and some medications.
The study showed practical guidance for doctors in determining psoriasis medicines particularly for patients who might be more susceptible to infections. Researchers further note that while some therapies were associated with isolated infection signals there were no significant differences between most systemic medications used to treat psoriasis in terms of risk of serious infections which highlights the importance of individualised treatment plans based on the history of each patient and their general health.
This summary is for informational purposes only and should not be considered medical advice. Patients should consult healthcare professionals regarding treatment decisions and infection risks.
