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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 )
Author(s) -
Yiu Z.Z.N.,
Ashcroft D.M.,
Evans I.,
McElhone K.,
Lunt M.,
Smith C.H.,
Walton S.,
Murphy R.,
Reynolds N.J.,
Ormerod A.D.,
Griffiths C.E.M.,
Warren R.B.
Publication year - 2019
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.17036
Subject(s) - medicine , infliximab , psoriasis , hazard ratio , cohort , relative risk , proportional hazards model , cohort study , surgery , confidence interval , dermatology , disease
Summary 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 ( HR s). 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 (adj HR ) 1·95, 95% CI 1·01–3·75] and methotrexate only (adj HR 2·96, 95% CI 1·58–5·57) and a higher risk of serious infection in the first 6 months of therapy (adj HR 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.