Lowest risk of infection after therapy with an IL-12/IL-23 blocker

In a cohort study using data from 2 large US claims databases, researchers assessed the comparative risk of serious infection during the use of biologics in patients with psoriasis and psoriatic arthritis (PsA) [1].

Although the risk of serious infections during the use of small molecules and biologic drugs is a major concern when treating patients with psoriasis or PsA, little is known on the comparative risk of infection among newer medications. To shed light on this important question, Dr Yinzhu Jin (Brigham and Women´s Hospital and Harvard Medical School, Boston, USA) and co-workers conducted a cohort study using the 2 large US databases MarketScan and Optum. They identified patients treated with ustekinumab, secukinumab, ixekizumab, or TNF inhibitors, and the immune modulator apremilast. Patients were required to have psoriasis or PsA diagnosis reported on consecutative occasions over 6 months or variant thereof. Those with a known recent serious infection, rheumatoid arthritis, inflammatory bowel disease, malignancy, HIV, or organ transplant at baseline were excluded. The primary study outcome was a composite endpoint of hospitalised serious infection including bacterial, viral, or opportunistic infection.

A total of 123,383 patients with psoriasis/PsA who initiated one of the study drugs was identified. Most of them had psoriasis (66%), 22% had PsA, and 17% had both diagnoses. The crude incidence rate of serious infection per 100 person-years was highest after use of infliximab (2.47 in MarketScan and 3.17 in Optum) and lowest with ixekizumab (0.69 in MarketScan) and ustekinumab treatment (1.03 in Optum). After propensity score-matching, a statistical matching technique used in observational studies to reduce the treatment assignment bias and mimic randomisation, the use of the IL-12/IL-23 blocker ustekinumab was associated with a lower risk of hospitalised serious infection compared with all other biologics and apremilast.

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   1. Jin Y et al. Abstract L01. ACR 2019, 9-13 November, Atlanta (GA/USA).

 



Posted on 4 February 202015 February 2024