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Risk of Serious Infections in Patients with Psoriasis on Biologic Therapies: A Systematic Review and Meta-Analysis

Lookup NU author(s): Dr Zarif Jabbar-Lopez



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


A comprehensive evaluation of the risk of serious infections in biologic therapies for psoriasis is lacking. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and prospective cohort studies reporting serious infections in people taking any licensed biologic therapy for psoriasis compared with those taking placebo, nonbiologic therapy, or other biologic therapies. The quality of the studies was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. No significant heterogeneity was detected in data from 32 RCTs (n = 13,359 participants) and one cohort study (n = 4,993 participants). In adults, low-to very-low-quality RCT data showed no significant difference between any biologic therapy and placebo at weeks 12-16 (overall pooled Peto odds ratio = 0.71, 95% confidence interval = 0.36-1.41) and weeks 20-30 (odds ratio = 2.27, 95% confidence interval = 0.45-11.49). No significant differences were found in any of the other comparisons in underpowered RCT data. Prospective cohort study data of low quality suggests that only adalimumab (adjusted hazard ratio [adjHR] = 2.52, 95% confidence interval = 1.47-4.32) was associated with a significantly higher risk of serious infection compared with retinoid and/or phototherapy in adults. No association between biologic therapies and serious infections in patients with psoriasis who were eligible for RCTs was detected. Further observational studies are needed to inform the uncertainty around this risk in the real world.

Publication metadata

Author(s): Yiu ZZN, Exton LS, Jabbar-Lopez Z, Mustapa MFM, Samarasekera EJ, Burden AD, Murphy R, Owen CM, Parslew R, Venning V, Ashcroft DM, Griffiths CEM, Smith CH, Warren RB

Publication type: Article

Publication status: Published

Journal: Journal of Investigative Dermatology

Year: 2016

Volume: 136

Issue: 8

Pages: 1584-1591

Print publication date: 01/08/2016

Online publication date: 13/04/2016

Acceptance date: 28/03/2016

Date deposited: 17/10/2016

ISSN (print): 0022-202X

ISSN (electronic): 1523-1747

Publisher: Elsevier


DOI: 10.1016/j.jid.2016.03.035


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Funder referenceFunder name
British Association of Dermatologists
NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London
DRF-2015-08-089National Institute for Health Research (NIHR)