Highlights from

WCD 2019

World Congress of Dermatology

Milan 10-15 June 2019

Infliximab associated with a 3-fold risk of serious infections

An analysis of the British BADBIR registry showed that psoriasis patients treated with infliximab have a 3-fold risk for serious infections compared with those treated with adalimumab, ustekinumab or conventional immunotherapeutics [1].

As systemic therapies for psoriasis suppress the immune systems, many patients and physicians fear side effects of biologics that may lead to non-adherence and impede therapeutic success. In addition, patients with moderate-to-severe psoriasis are prone to infections due to their condition, associated comorbidity, and lifestyle factors [2].

An analysis of the British Association of Dermatologists Biologics and Immunomodulator Registry (BADBIR) assessed the risk of serious infections during treatment with infliximab, etanercept, and ustekinumab compared with conventional immunosuppressants. Founded in 2007, BADBIR is a prospective safety registry including British and Irish psoriasis patients that were treated with a systemic immunosuppressant (either the biologic adalimumab, infliximab, ustekinumab, or the conventional immunosuppressants cyclosporin, methotrexate, psoralen-UVA, acitretin, hydroxycarbamide, or fumaric acid esters). Serious infections were defined as infections that required hospitalisation, intravenous antibiotics, and/or death.

In a second part of the analysis, a multivariable prediction model of risk factors for serious infections was developed to analysis data from 9,480 patients. Therapy with non-biologics, etanercept, adalimumab, and ustekinumab led to a similar crude incidence rate of serious infections (14.2/1,000 person years with non-biologics compared with 15.3/1,000 person years with etanercept, 13.8/1,000 person years with adalimumab, and 15.1/,1000 persons years with ustekinumab). In contrast, therapy with infliximab was associated with a crude incidence rate of serious infections of 47.8/1,000 persons years. This translates into a 3-fold elevated relative risk when patients were treated with infliximab compared with the other biologics or systemic immunosuppressants.

Factors associated with a higher risk of serious infections in the multivariate risk models were therapy with infliximab, patients with a comorbid condition of chronic obstructive pulmonary disease, and retired patients.

  1. Yiu ZZ, Smith CH, Ashcroft D et al. Association and prediction of serious infection in patients with psoriasis on biologic therapies: A cohort study from the British Association of Dermatologists Biologics and Immunomodulators Register. Poster presented at the World Congress of Dermatology 2019, 10-15 June, Milan, Italy.
  2. Wakkee M et al. Increased risk of infectious disease requiring hospitalization among patients with psoriasis: a population-based cohort. J Acad Dermatol Venereol 2011;65:1135-44.

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