Infliximab is associated with an increased risk of serious infection in patients with psoriasis in the United Kingdom and Republic of Ireland:results from the British Association of Dermatologists Biologic Interventions Register (BADBIR)

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 non-biologic systemic therapies.METHODS: A prospective cohort study was performed using data from BADBIR. Infliximab was compared to non-biologic systemic therapies, inclusive of any exposure to methotrexate, ciclosporin, acitretin, fumaric acid esters, psoralen-ultraviolet A or hydroxycarbamide. Serious infections were those associated with hospitalisation; the use of intravenous antimicrobial therapy; and/or 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.RESULTS: 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 to 14.2 per 1000 person-years (95% CI 11.5, 17.4) in the non-biologic systemic cohort. Infliximab was associated with an overall increase in the risk of serious infection against non-biologics (adjusted hazard ratio (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 non-biologic systemic therapies in patients with psoriasis in the United Kingdom and the Republic of Ireland. This article is protected by copyright. All rights reserved.