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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)

Lookup NU author(s): Professor Nick Reynolds

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

© 2018 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists. 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.


Publication metadata

Author(s): Yiu ZZN, Ashcroft DM, Evans I, McElhone K, Lunt M, Smith CH, Walton S, Murphy R, Reynolds NJ, Ormerod AD, Griffiths CEM, Warren RB, BADBIR Study Group

Publication type: Article

Publication status: Published

Journal: British Journal of Dermatology

Year: 2019

Volume: 180

Issue: 2

Pages: 329-337

Print publication date: 01/02/2019

Online publication date: 02/08/2018

Acceptance date: 13/06/2018

Date deposited: 05/11/2018

ISSN (print): 0007-0963

ISSN (electronic): 1365-2133

Publisher: Wiley-Blackwell

URL: https://doi.org/10.1111/bjd.17036

DOI: 10.1111/bjd.17036


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