Risk of serious infections in patients with psoriasis on biologic therapies: a systematic review and meta-analysis

Yiu, Z. Z.N. et al. (2016) Risk of serious infections in patients with psoriasis on biologic therapies: a systematic review and meta-analysis. Journal of Investigative Dermatology, 136(8), pp. 1584-1591. (doi: 10.1016/j.jid.2016.03.035) (PMID:27085754) (PMCID:PMC4946794)

Abstract

A comprehensive evaluation of the risk of serious infections in biologic therapies for psoriasis is lacking. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and prospective cohort studies reporting serious infections in people taking any licensed biologic therapy for psoriasis compared with those taking placebo, nonbiologic therapy, or other biologic therapies. The quality of the studies was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. No significant heterogeneity was detected in data from 32 RCTs (n = 13,359 participants) and one cohort study (n = 4,993 participants). In adults, low- to very-low-quality RCT data showed no significant difference between any biologic therapy and placebo at weeks 12–16 (overall pooled Peto odds ratio = 0.71, 95% confidence interval = 0.36–1.41) and weeks 20–30 (odds ratio = 2.27, 95% confidence interval = 0.45–11.49). No significant differences were found in any of the other comparisons in underpowered RCT data. Prospective cohort study data of low quality suggests that only adalimumab (adjusted hazard ratio [adjHR] = 2.52, 95% confidence interval = 1.47–4.32) was associated with a significantly higher risk of serious infection compared with retinoid and/or phototherapy in adults. No association between biologic therapies and serious infections in patients with psoriasis who were eligible for RCTs was detected. Further observational studies are needed to inform the uncertainty around this risk in the real world.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Burden, Professor David
• Authors: Yiu, Z. Z.N., Exton, L. S., Jabbar-Lopez, Z., Mohd Mustapa, M. F., Samarasekera, E. J., Burden, A. D., Murphy, R., Owen, C. M., Parslew, R., Venning, V., Ashcroft, D. M., Griffiths, C. E.M., Smith, C. H., and Warren, R. B.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Journal Name: Journal of Investigative Dermatology
• Publisher: Elsevier
• ISSN: 0022-202X
• ISSN (Online): 1523-1747
• Copyright Holders: Copyright © 2016 The Authors
• First Published: First published in Journal of Investigative Dermatology 136(8):1584-1591
• Publisher Policy: Reproduced under a Creative Commons licence