Newer Biologics safer than Methotrexate for treatment of psoriasis, JAMA Dermatology

Newer systemic biologics have a decreased rate of serious infection in comparison to methotrexate in psoriasis treatment, finds a new study publshed in the journal JAMA Dermatology.

Psoriasis is a common, chronic inflammatory disease of the skin caused by the overactive immune system. The introduction of biologics has brought a revolution in the treatment standards of psoriasis. Systemic medications available in the United States and approved by the US FDA for moderate-to-severe and severe psoriasis include older agents such as acitretin and methotrexate, as well as novel agents including the biologics and apremilast, a small molecule inhibitor of phosphodiesterase.

Despite their efficacy, adherence to biologics and systemic medications for psoriasis is low, with infection having been shown to be a leading cause of discontinuation.

Psoriasis patients are at a higher risk of developing a serious infection. The study used 2 large electronic databases to compare the risk of serious infection in patients with psoriasis who were new users of 6 systemic medications (acitretin, adalimumab, apremilast, etanercept, infliximab, and ustekinumab) to new users of methotrexate using a large national cohort of commercially insured US adults.

The researchers analyzed the occurrence of primary outcome identified as serious infection requiring hospitalization, using previously validated ICD-9-CM codes with an overall positive predictive value of 90.2%. Serious infection was defined as a primary inpatient diagnosis code for pneumonia, meningitis/encephalitis, bacteremia/sepsis, cellulitis/soft-tissue infection, endocarditis, pyelonephritis, and septic arthritis/osteoarthritis. We also conducted secondary analyses examining each type of serious infection separately.

The researchers identified 31 595 patients in claims data from Optum Clinformatics Data Mart and 76,112 patients in Truven MarketScan from 2003 through 2015 who were new users of acitretin, adalimumab, apremilast, etanercept, infliximab, methotrexate, and ustekinumab.

The researchers found a significantly decreased rate of serious infection with apremilast, etanercept, and ustekinumab compared with methotrexate. In both claims databases, investigators observed a lower risk of overall serious infections among patients receiving apremilast (hazard ratio, etanercept, and ustekinumab compared to methotrexate. There was not a difference in rate of overall serious infections among patients using acitretin, adalimumab, and infliximab compared with methotrexate.

To know more about the study, please click on the link

doi:10.1001/jamadermatol.2019.1121