Risk of common infections among individuals with psoriasis in Sweden: A nationwide cohort study comparing secukinumab to ustekinumab

Abstract

Purpose: To determine risk of respiratory tract infections, urinary tract infections and candidiasis in secukinumab users compared to ustekinumab users among individuals with psoriasis in Sweden. Methods: This was a Swedish population-based register-linked new-user cohort study on individuals with psoriasis and psoriasis arthritis treated with secukinumab (2015-2017) and ustekinumab (2009-2017). Ever-never exposure definition was used, that is, each individual's follow-up time was attributed to the drug they were first exposed to. Risk of severe respiratory and urinary tract infections and candidiasis (diagnosis codes from outpatient specialist visits and in-patient hospitalisations) and respiratory and urinary tract infections treated in primary care (proxied by dispensation of antibiotics) was determined by adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox regression. We also give crude incidence rates and rate ratios. Results: In total, 1955 new users of secukinumab (n = 848) and ustekinumab (n = 1107) were identified. There was a slightly increased risk of respiratory and urinary tract infections treated in primary care among secukinumab users compared to ustekinumab users (HR: 1.22, 95% CI: 1.03-1.43). Non-significant differences in estimated risk of severe respiratory and urinary tract infections (HR: 0.96, 95% CI: 0.57-1.61) and candidiasis (HR: 1.80, 95% CI: 0.84-3.84) treated in the hospital setting were observed. Conclusion: We observed a slightly increased risk of respiratory and urinary tract infections treated in primary care among secukinumab users compared to ustekinumab users. Larger studies with longer follow-up are needed to draw conclusions on relative safety.

Review and Practical Guidance on Managing Fungal Infections in Patients With Psoriasis Receiving Anti-IL-17 Therapies

“…A total of 3 patients discontinued treatment. [46][47][48] Following 2 years of treatment with brodalumab, 2 of 2677 patients reported oral candidiasis, one of which discontinued due to the infection. 49…”

Risk of respiratory tract infections and serious infections in psoriasis patients treated with biologics: Results from the BioCAPTURE registry

“…Of note, this comparison is based on a low event rate and could therefore have been underpowered. Most previously conducted observational studies did not observe an increased risk of SI among biologics users as well, but biologics were compared with nonbiologic systemic treatments and included mostly the ‘older’ generation biologics 24–29 . Regarding the ‘newer’ biologics, few studies are available.…”

“…Most previously conducted observational studies did not observe an increased risk of SI among biologics users as well, but biologics were compared with nonbiologic systemic treatments and included mostly the 'older' generation biologics. [24][25][26][27][28][29]…”

“…For instance, increased risks of SI were reported, [21][22][23] while other studies did not observe higher risks for biologics compared with conventional systemic treatments. [24][25][26][27][28][29] Limited real-world studies comparing SI risk between biologics, including newer generation biologics, are available. 27,30,31 In conclusion, more comparative real-world data regarding infection risk in psoriasis patients treated with biologics is warranted to guide tailored treatment choices.…”

The Risk of COVID-19 Pandemic in Patients with Moderate to Severe Plaque Psoriasis Receiving Systemic Treatments

“…IL-17A in viral infections may contribute to secondary inflammatory injury recruiting neutrophils and lymphocytes, and its levels have been found to be elevated in patients with severe COVID-19 pneumonia [32]. A slightly reduced risk of respiratory infections among patients treated with ustekinumab versus secukinumab was reported in a Swedish population-based register-linked cohort study [33]. Data from pharmacovigilance indicate that anti-IL-23 biologics are not associated with additional risk of infection.…”