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Br J Dermatol. 2019 Feb;180(2):329-337. doi: 10.1111/bjd.17036. Epub 2018 Oct 21.

Infliximab is associated with an increased risk of serious infection in patients with psoriasis in the U.K. and Republic of Ireland: results from the British Association of Dermatologists Biologic Interventions Register (BADBIR).

Author information

1
Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, M13 9PT, U.K.
2
Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences and, Manchester, M13 9PT, U.K.
3
Arthritis Research U.K. Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, M13 9PT, U.K.
4
St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K.
5
Department of Dermatology, Castle Hill Hospital, Hull, HU16 5JQ, U.K.
6
Sheffield University Teaching Hospitals and Sheffield Children's Hospitals, Sheffield, S10 2JF, U.K.
7
Dermatological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University and Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE2 4HH, U.K.
8
Division of Applied Medicine, University of Aberdeen, Aberdeen, AB25 2ZD, U.K.

Abstract

BACKGROUND:

Patients with psoriasis and clinicians are concerned that infliximab may be associated with a risk of serious infections.

OBJECTIVES:

To compare the risk of serious infections associated with infliximab in patients with chronic plaque psoriasis against a cohort on nonbiologic systemic therapies.

METHODS:

A prospective cohort study was performed using data from the British Association of Dermatologists Biologic Interventions Register (BADBIR). Infliximab was compared with nonbiologic systemic therapies, inclusive of any exposure to methotrexate, ciclosporin, acitretin, fumaric acid esters, psoralen-ultraviolet A or hydroxycarbamide. Serious infections were those associated with hospitalization, the use of intravenous antimicrobial therapy and/or those that led to death. Propensity score inverse probability treatment weights were used to adjust for potential confounding from a priori identified covariates. Cox proportional hazards models were calculated to obtain hazard ratios (HRs).

RESULTS:

In total, 3843 participants were included for analysis up to October 2016. The incidence rates were significantly higher in the infliximab cohort (47·8 per 1000 person-years) [95% confidence interval (CI) 35·7-64·0], compared with 14·2 per 1000 person-years (95% CI 11·5-17·4) in the nonbiologic systemic cohort. Infliximab was associated with an overall increase in the risk of serious infection compared with nonbiologics [adjusted HR (adjHR) 1·95, 95% CI 1·01-3·75] and methotrexate only (adjHR 2·96, 95% CI 1·58-5·57) and a higher risk of serious infection in the first 6 months of therapy (adjHR 3·49, 95% CI 1·14-10·70).

CONCLUSIONS:

Infliximab is associated with an increased risk of serious infections compared with nonbiologic systemic therapies in patients with psoriasis in the U.K. and the Republic of Ireland.

PMID:
30070708
DOI:
10.1111/bjd.17036

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