Beth Israel Deaconess Medical Center conducted an observational cohort study, finding less risk of serious infection in patients taking newer targeted systemic medications for psoriasis as recently reported in EurekAlert!
A common chronic skin condition affecting 125 million people worldwide, psoriasis is an autoimmune disease. Biologic treatments are used to combat many of these diseases where the immune system attacks the body’s own healthy cells but inhibiting the overactive immune system by targeting specific inflammatory pathways. They have profound influence on the medical community but many side effects are known, and this study is the first to review the comparative safety of the various biologics.
In what is purported to be the largest of this type of study, clinician-researchers compared the risk of serious infection across seven systemic medications used for psoriasis treatment. The study leaders found a decreased risk of infection in patients with psoriasis using some of the newer, more targeted medications compared to those taking methotrexate, a drug widely used in the 1960s as a first line treatment for moderate to severe psoriasis. These findings were presented at the Society for Investigative Dermatology meeting in Chicago and published concurrently in JAMA Dermatology.
To conduct this large, retroactive observational comparative cohort study, the investigators used two large insurance claims databases that included more than 250 million people in the U.S. The dermatologists tracked the incidence of serious infection requiring hospitalization in approximately 107,000 patients with psoriasis who had a prescription claim for one of seven systemic medications FDA-approved for the treatment of moderate-to-severe psoriasis including older systemic medications (acitretin and methotrexate), biologics (adalimumab, etanercept, infliximab, and ustekinumab) and a small-molecule inhibitor (apremilast).
Certain immune system proteins, called cytokines, are important in causing psoriasis. Newer treatments, such as the biologics, work by inhibiting different types of cytokines. Some of the earliest biologics, including adalimumab, etanercept, and infliximab, work by inhibiting tumor necrosis (TNF)-alpha, a protein broadly involved in inflammation. Newer biologics are more targeted to the inflammatory pathways involved in psoriasis, including ustekinumab, which works by blocking two proteins — interleukin-17 and -23. These newer agents have been shown to be more effective in treating psoriasis and could also be safer given their more specific action on the immune system. Apremilast, a newer non-biologic systemic treatment or psoriasis, does not directly inhibit inflammatory cytokines and is thought to have no increased risk of infection; however, it is generally less effective in treating psoriasis.
About Beth Israel Deaconess Medical Center
Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School and consistently ranks as a national leader among independent hospitals in National Institutes of Health funding. Beth Israel Deaconess Medical Center is part of Beth Israel Lahey Health, a new health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,000 physicians and 35,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.