Antibiotic Use May Reduce Biologic Treatment Persistence in Psoriasis: JAMA
A new study published in the Journal of American Medical Association showed that psoriasis patients who used antibiotics had a higher risk of stopping their biologic medications earlier. The analysis used the French National Health Insurance database and included patients receiving biologic therapies for psoriasis. While antibiotic exposure was associated with reduced biologic treatment persistence, the study did not establish a direct cause-and-effect relationship.
The effectiveness of long-term biologic therapy for psoriasis can be somewhat impacted by antibiotic usage. Antibiotics may affect treatment response or cause therapy pauses because they can change the immune system and gut microbiota. Investigating this relationship aids in determining if repeated exposure to antibiotics influences biologic persistence and directs medical professionals in providing the best possible therapy for patients with persistent psoriasis. Thus, this study assessed the relationship between antibiotic exposure and biologic therapy persistence in psoriasis patients.
The French National Health Insurance database provided data for this retrospective cohort analysis between June 2011 and December 2022. Adults starting a biologic treatment for psoriasis were included; those who had inflammatory bowel disease at baseline were not. The period of data analysis was January through September of 2024. Antibiotic exposure was categorized at baseline as either none, one, or two or more dispensations over the six months prior to the index date. Time-dependent antibiotic exposure during follow-up was defined as nil, one, two, or more antibiotic dispensations in the six months before each follow-up period.
The main result was switching or stopping the original biologic treatment. Antibiotic exposure was measured throughout follow-up and within six months after starting a biologic. Adjusted hazard ratios were estimated using a weighted Cox marginal structural model. The mean (SD) age of the 36 129 patients was 48.4 (15.1) years, with 11 228 (42.0%) being female and 20 192 (55.9%) being male.
At baseline, 9366 (25.9%) and 21,900 (60.6%) individuals were exposed to antibiotics. β-lactams, macrolides, and fluoroquinolones were the most often prescribed classes of antibiotics. A dose-response connection was shown by the greater probability of biologic cessation linked to antibiotic exposure (weighted hazard ratio, 1.12; 95% CI, 1.08-1.16), which was more pronounced for numerous dispensations (weighted hazard ratio, 1.29; 95% CI, 1.24-1.35).
Overall, antibiotic exposure was substantially linked to a higher likelihood of stopping biologic treatments for psoriasis in this cohort research. These results provide credence to the theory that antibiotics may lessen biologic persistence through gut dysbiosis. However, the interpretation of causality is limited by unmeasured confounders.
Source:
Ouakrat, R., Penso, L., Jullien, D., Sokol, H., & Sbidian, E. (2025). Antibiotic use and the persistence of biologic therapies in patients with psoriasis. JAMA Dermatology (Chicago, Ill.). https://doi.org/10.1001/jamadermatol.2025.4427
