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Risk of Serious Infection in Patients with Psoriasis Receiving Biologic Therapies: A Prospective Cohort Study from the British Association of Dermatologists Biologic Interventions Register (BADBIR)

Lookup NU author(s): Professor Nick ReynoldsORCiD



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


© 2017 The Authors Serious infection is a concern for patients with psoriasis receiving biologic therapies. We assessed the risk of serious infections for biologics used to treat psoriasis by comparison with a cohort receiving non-biologic systemic therapies in a propensity score-weighted Cox proportional hazards model using data from the British Association of Dermatologists Biologic Interventions Register. Overall, 1,352; 3,271; and 994 participants were included in the etanercept, adalimumab, ustekinumab cohorts, respectively, and 3,421 participants were in the non-biologic cohort. A total of 283 patients had a serious infection; the incidence rates with 95% confidence intervals (CI) per 1,000 person-years were as follows: non-biologic, 14.2 (11.5–17.4); etanercept, 15.3 (11.6–20.1); adalimumab, 13.9 (11.4–16.6); and ustekinumab, 15.1 (10.8–21.1). No significant increases in the risk of serious infection were observed for etanercept (hazard ratio [HR] = 1.10, 95% CI = 0.75–1.60), adalimumab (HR = 0.93, 95% CI = 0.69–1.26), or ustekinumab (HR = 0.92, 95% CI = 0.60–1.41) compared with non-biologic systemic therapies or methotrexate-only (etanercept: HR = 1.47, 95% CI = 0.95–2.28; adalimumab: HR = 1.26, 95% CI = 0.86–1.84; ustekinumab: HR = 1.22, 95% CI = 0.75–1.99). The risk of serious infection should not be a key discriminator for patients and clinicians when choosing between non-biologic systemic therapies, etanercept, adalimumab, and ustekinumab for the treatment of psoriasis.

Publication metadata

Author(s): Yiu ZZN, Smith CH, Ashcroft DM, Lunt M, Walton S, Murphy R, Reynolds NJ, Ormerod AD, Griffiths CEM, Warren RB

Publication type: Article

Publication status: Published

Journal: Journal of Investigative Dermatology

Year: 2018

Volume: 138

Issue: 3

Pages: 534-541

Print publication date: 01/03/2018

Online publication date: 17/10/2017

Acceptance date: 08/10/2017

Date deposited: 12/03/2018

ISSN (print): 0022-202X

ISSN (electronic): 1523-1747

Publisher: Elsevier B.V.


DOI: 10.1016/j.jid.2017.10.005


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