In a prospective cohort study from BADBIR (09/2007-10/2016), we compared the risk of serious infections (SI) associated with the use of biologic therapies in patients with psoriasis against a cohort on non-biologic systemic therapies (non-biologics). Etanercept, adalimumab, and ustekinumab were compared to non-biologics, inclusive of any exposure to methotrexate, ciclosporin, acitretin, fumaric acid esters, psoralen-ultraviolet A, hydroxycarbamide. SI were defined by association with hospitalisation; use of intravenous antimicrobial therapy; and/or led to death. Incidence rates to first SI were measured. Propensity-score weighted Cox proportional hazards models were used to compare the risk of SI and hazard ratios were derived. 1352, 3271 and 994 biologic-naïve participants were included in the etanercept, adalimumab and ustekinumab cohorts respectively and 3421 biologic-naïve participants were included in the non-biologic cohort. In total, 283 patients had a SI; the incidence rates were: non-biologic 14.2/1000 person-years (95% confidence interval [CI] 11.5 to 17.4); etanercept 15.3/1000 person-years (11.6 to 20.1); adalimumab 14.8/1000 person-years (11.4 to 16.6); ustekinumab 15.1/1000 person-years (10.8 to 21.1). No statistically significant increases in the risk of SI were observed for etanercept (hazard ratio [HR] 1.10; 95% CI 0.75 to 1.60); adalimumab (HR 0.93, 95% CI 0.69 to 1.26) or ustekinumab (HR 0.92, 95% CI 0.60 to 1.41) compared to non-biologics. Our results suggest that the risk of SI should not be a key discriminator when choosing between non-biologics, etanercept, adalimumab and ustekinumab for the treatment of psoriasis.

Risk of Serious Infection Associated With Biologic Therapies in Psoriasis : a Prospective Cohort Study from the British Association of Dermatologists Biologic Interventions Register (BADBIR)