Two biologics for treating psoriasis, adalimumab and infliximab, may put new users at a relatively higher risk of developing a serious infection, according to a recent study. The study, published in JAMA Dermatology, also found that some other biologics did not increase infection rates compared to etanercept — and that ustekinumab was associated with a lower risk of infection.
Biologics are human-made proteins that work by dampening the immune system. These drugs are useful for treating autoimmune diseases where the immune system is attacking the body’s healthy tissues. However, they also limit the immune system’s ability to fight off infections from bacteria and viruses.
“Prior observational studies have provided conflicting results on the risk of infection related to use of biologics,” according to the researchers, per The American Journal of Managed Care. Given these previous conflicting findings, the research team wanted to conduct the study in a large group of participants to better determine which biologics increased the risk of infection.
There are several different biologics that are prescribed to treat moderate to severe psoriasis. Each drug targets a different part of the immune system that has been overactivated, causing the disease.
The researchers studied the two main classes of biologics: TNF inhibitors and interleukin (IL) inhibitors. The TNF inhibitors included:
The IL inhibitors included:
The study, conducted in France, followed 44,239 people who were new users of biologic medications or apremilast (sold under the brand name Otezla), an anti-inflammatory medication used to treat psoriasis. The researchers excluded individuals with HIV or previous history of cancer, transplant, or recent serious infection.
Overall, there were 1,656 cases of serious infections. The most common of those were gastrointestinal (645), and skin and subcutaneous tissues (324). The average time for these infections to develop after beginning biologic treatment was nine months.
The researchers found that the risk of serious infection increased for new users of adalimumab (by 22 percent) and infliximab (by 79 percent) when compared to those who took etanercept.
On the other hand, the risk of developing a serious infection was reduced by 21 percent for new users of ustekinumab, compared to those who took etanercept. They also found that there was no increased risk of infection for those taking secukinumab, ixekizumab, brodalumab, guselkumab, and apremilast.
It is important to note that these study findings do not mean that everyone will develop a serious infection after taking these medications. Other observational studies are needed to confirm results for the most recent drugs, according to the researchers. Talk to your doctor if you have questions about your current medication.