Boston—Despite concerns about adverse effects, biologic treatment of psoriasis actually might be safer—as well as more effective—than some older medications.

That’s according to a new, large study, recently published in JAMA Dermatology, where researchers compared the risk of one of the most worrisome biologic side effects, serious infection, across seven systemic medications used for the treatment of psoriasis.

Results actually showed decreased risk of infection in patients with psoriasis using some of the newer, more targeted medications—specifically, apremilast, etanercept, and ustekinumab—compared with those taking methotrexate, a drug used since the 1960s as a first-line treatment for moderate-to-severe psoriasis. The findings, involving more than 107,000 patients, also were presented at the Society for Investigative Dermatology meeting in Chicago.

“In addition to being potentially more effective than methotrexate, some of the newer targeted treatments for psoriasis may also be safer for patients in terms of risk of infection,” explained lead author Erica D. Dommasch, MD, MPH, a dermatologist at Beth Israel Deaconess Medical Center and an Instructor of Dermatology at Harvard Medical School. “Doctors and patients may want to consider the risks of infection when choosing a systemic treatment for patients with moderate to severe psoriasis.”

To reach those conclusions, researchers conducted an observational cohort study using medical and outpatient pharmacy claims from two large U.S. health-insurance claims databases from January 1, 2003, through September 30, 2015. The focus was on patients with a diagnosis of psoriasis who were new users of systemic medications for psoriasis, including acitretin, adalimumab, apremilast, etanercept, infliximab, methotrexate, or ustekinumab—and serious infection was defined as the primary outcome.

The study team notes that users of acitretin, apremilast, infliximab, and methotrexate were older and had higher baseline comorbidity scores than subcutaneous biologic users (adalimumab, etanercept, and ustekinumab).

After analysis, results indicate that overall serious infection rates were decreased in users of apremilast (hazard ratio [HR], 0.50; 95% CI, 0.26-0.94), etanercept (HR, 0.75; 95% CI, 0.61-0.93), and ustekinumab (HR, 0.65; 95% CI, 0.47-0.89) compared with methotrexate.

No difference in rate of overall serious infection was determined among users of acitretin, adalimumab, and infliximab compared with methotrexate, study authors said. They cautioned, however, that subanalysis by type of serious infection showed a significantly increased risk of cellulitis among users of acitretin compared with methotrexate (PS-adjusted HR, 1.76; 95% CI, 1.11-2.80).

Researchers suggested that the finding that ustekinumab had a decreased risk of serious infection might mean that biologics more specifically targeted to inflammatory pathways in psoriasis could be both more effective and safer when it comes to risk of infection.

“This information should be considered when prescribing therapies for individual patients,” Dommasch said. “This study demonstrates how researchers can use ‘big data’ to help compare the safety of different medications for patients with psoriasis.”

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