Comparative Infectious Risk of Immunosuppressive Therapies Used in Psoriasis

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

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