Biologic treatments are not only effective but also have less risk of serious infection in patients of advanced psoriasis, finds new study
Biologic treatments have changed the face of psoriasis treatment.
Psoriasis is a chronic autoimmune disease, a class of disorders in which the immune system attacks the body’s own healthy cells. In recent years, new medications, known as biologics – that inhibit the overactive immune system by targeting specific inflammatory pathways, have revolutionized the treatment of psoriasis and other autoimmune diseases.
Researchers compared the risk of serious infection across seven systemic medications used for the treatment of psoriasis. Results showed a decreased risk of infection in patients with psoriasis using some of the newer, more targeted medications compared to those taking methotrexate, a drug widely used since the 1960s as a first line treatment for moderate-to-severe psoriasis. The findings were published in JAMA Dermatology.
The team found a significantly decreased risk of serious infection with apremilast, etanercept and ustekinumab compared to methotrexate
“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,” said lead author Erica D. Dommasch, MD, MPH, a dermatologist in the Department of Dermatology at BIDMC.
In psoriasis, skin cells proliferate too quickly – about ten times faster than normal – and the excess cells build up into scaly thick patches of itchy dry skin, especially on the scalp, elbows and knees. Methotrexate, an anti-inflammatory drug that blocks cells’ ability to grow. But because methotrexate acts on all cells of the body, its use has the potential to result in unwanted side effects, including serious infection. The newer agents have been shown to be more effective in treating psoriasis and could also be safer given their more specific action on the immune system.
Researchers tracked the incidence of serious infection requiring hospitalization in approximately 107,000 American patients with psoriasis who had a prescription claim for one of seven systemic medications FDA-approved for the treatment of moderate-to-severe psoriasis including older systemic medications (acitretin and methotrexate), biologics (adalimumab, etanercept, infliximab, and ustekinumab) and a small-molecule inhibitor (apremilast).
The most common types of serious infection found were cellulitis, pneumonia, and bacteremia/sepsis among patients taking any systemic medications. The team found a significantly decreased risk of serious infection with apremilast, etanercept and ustekinumab compared to methotrexate. They did not find a different rate of overall infection among users of acitretin, adalimumab and infliximab compared to methotrexate. The finding that ustekinumab had a decreased risk of serious infection is suggestive that biologics more specifically targeted to inflammatory pathways in psoriasis may be both more effective and safer when it comes to risk of infection.
“This information should be considered when prescribing therapies for individual patients,” said Dommasch.
