Sage Journals: Discover world-class research

Abstract

Few population-based studies have evaluated the infectious risk of immunosuppressive therapies used in psoriasis. Using Medicare, we identified psoriasis patients using anti-TNF therapies, ustekinumab, cyclosporine, methotrexate, or ultraviolet light. We calculated incidence rates (IRs per 1000 person-years) of hospitalized infections and opportunistic infections and used Cox-proportional hazard modeling to compare risk between therapies. Among 30,451 psoriasis patients, we identified 3,124 hospitalized infections [crude IR 160.0 (95% CI 102.3–109.7)]. Crude IRs were lowest for ultraviolet (UV) therapy [crude IR 90.0 (95% CI 82.2–98.5)] and highest for cyclosporine [crude IR 160.1 (95% CI 123.5–207.6)]. Patients starting cyclosporine (HR 1.4 [95% CI 1.1–1.9]) or methotrexate (HR 1.2 [95% CI 1.1–1.4]) or anti-TNF therapy (HR 1.2 [95% CI 1.04–1.3]) were at higher risk compared to UV therapy. Herpes zoster was the most common opportunistic infection [crude IR 13.7 (95% CI: 12.4–15.1)], although risk was similar by exposure group.

Keywords

psoriasis infection herpes zoster comparative effectiveness tumor necrosis factor alpha antagonists

Get full access to this article

View all access options for this article.

References

Langley

R.G.

Krueger

G.G.

Griffiths

C.E.

. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis. 2005; 64 Suppl 2: ii18–23; discussion ii24–15.

Cohen

M.J.

Benenson

. Surveillance quality in reporting nosocomial bloodstream infection rates. JAMA. 2011; 305(8): 779–780; author reply 780.

Wakkee

de Vries

van den Haak

Nijsten

. Increased risk of infectious disease requiring hospitalization among patients with psoriasis: a population-based cohort. J Am Acad Dermatol. 2011; 65(6): 1135–1144.

Winthrop

K.L.

. Infections and biologic therapy in rheumatoid arthritis: our changing understanding of risk and prevention. Rheum Dis Clin North Am. 2012; 38(4): 727–745.

Winthrop

K.L.

Baddley

J.W.

Chen

Association between the initiation of anti-tumor necrosis factor therapy and the risk of herpes zoster.

JAMA. 2013; 309(9): 887–895.

Grijalva

C.G.

Chen

Delzell

Initiation of tumor necrosis factor-alpha antagonists and the risk of hospitalization for infection in patients with autoimmune diseases.

JAMA. 2011; 306(21): 2331–2339.

Herrinton

L.J.

Curtis

J.R.

Chen

Study design for a comprehensive assessment of biologic safety using multiple healthcare data systems.

Pharmacoepidemiol Drug Saf. 2011; 20(11): 1199–1209.

Baddley

J.W.

Winthrop

K.L.

Chen

Non-viral opportunistic infections in new users of tumour necrosis factor inhibitor therapy: results of the SAfety Assessment of Biologic ThERapy (SABER) study.

Ann Rheum Dis. 2014; 73(11): 1942–1948.

Dixon

W.G.

Watson

Lunt

Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: results from the British Society for Rheumatology Biologics Register.

Arthritis Rheum. 2006; 54(8): 2368–2376.

10.

Lin

D.Y.

Wei

L.J.

. The Robust Inference for the Cox Proportional Hazards Model. J Am Stat Assoc. 1989; 84(408): 1074–1078.

11.

Kalb

R.E.

Fiorentino

D.F.

Lebwohl

M.G.

Risk of Serious Infection With Biologic and Systemic Treatment of Psoriasis: Results From the Psoriasis Longitudinal Assessment and Registry (PSOLAR).

JAMA Dermatol. 2015 Sep; 151(9): 961–9.

12.

Shalom

Zisman

Bitterman

Systemic Therapy for Psoriasis and the Risk of Herpes Zoster: A 500,000 Person-year Study.

JAMA Dermatol. 2015; 151(5): 533–538.

13.

Yun

Xie

Delzell

Risk of hospitalised infection in rheumatoid arthritis patients receiving biologics following a previous infection while on treatment with anti-TNF therapy.

Ann Rheum Dis. 2015; 74(6): 1065–1071.

14.

Insinga

R.P.

Itzler

R.F.

Pellissier

J.M.

Saddier

Nikas

A.A.

. The incidence of herpes zoster in a United States administrative database. J Gen Intern Med. 2005; 20(8): 748–753.

15.

Winthrop

K.L.

Novosad

S.A.

Baddley

J.W.

Opportunistic infections and biologic therapies in immune-mediated inflammatory diseases: consensus recommendations for infection reporting during clinical trials and postmarketing surveillance.

Ann Rheum Dis. 2015 Dec; 74(12): 2107–16.

16.

Centers for Disease C, Prevention.

Trends in tuberculosis - United States, 2013.

MMWR Morb Mortal Wkly Rep. 2014; 63(11): 229–233.

17.

Winthrop

K.L.

Baxter

Liu

The reliability of diagnostic coding and laboratory data to identify tuberculosis and nontuberculous mycobacterial disease among rheumatoid arthritis patients using anti-tumor necrosis factor therapy.

Pharmacoepidemiol Drug Saf. 2011; 20(3): 229–235.

Comparative Infectious Risk of Immunosuppressive Therapies Used in Psoriasis

Abstract

Keywords

Get full access to this article

References