Biologic Treatment of Psoriasis Raises Infection Risk
Biologic agents such as tumor necrosis factor-a (TNF-a) inhibitors, interleukin (IL) 12/IL-23 inhibitors, and IL-17 inhibitors have proven to be an effective treatment option for patients with moderate-to-severe psoriasis. However, as these agents target key components of the dysregulated inflammatory response, they also have overall effects on immune function which may place patients at greater risk for infections.
A recent study looked at the incidence of serious infections, defined as an infection that requires hospitalization and treatment with systemic antibiotics, among a cohort of patients with moderate-to-severe psoriasis. Patients were newly diagnosed with psoriasis and treated for periods of time with either a biologic agent, a nonbiologic agent, or no active systemic treatment. Patients were assessed for serious infection outcomes including: sepsis, pneumonia, skin and soft tissue infections (SSTIs), meningitis, and renal/urinary tract infections.
The results showed that overall infection rates were higher in patients treated with biologics, especially for SSTIs. Patients with psoriasis who were actively taking biologics had a 75% increased risk for development of SSTIs compared with users of nonbiologics. In addition, there was also an increased risk for meningitis among users of biologics, but the authors urge caution with that result because the increased risk was based on only 7 patients with meningitis. There was no significant difference in pneumonia, sepsis, or renal/urinary tract infections.
The authors conclude that based on the data from this cohort, use of a biologic increases the risk for overall serious infections, and more specifically SSTIs. They note that psoriasis patients with a predisposition to SSTIs, such as persons with diabetes, peripheral vascular disease, and obesity may benefit from increased counseling about the risk for SSTIs. Patients with systemically treated psoriasis should be counseled about early signs of infection, and monitored for SSTIs.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: November 20, 2017
Adapted from the original article.