Certain biologics May Reduce Infection Risk among elderly with Psoriasis: JAMA
A new cohort study published in Journal of American Medical Association suggests that biologics targeting IL-12, IL-23, and IL-17 may be associated with lower rates of serious infection among older adults with psoriasis and psoriatic arthritis. Therefore considering their established efficacy, these biologics could be preferred over other treatment options for older patients. This study was conducted by Aaron M. and fellow researchers in Canada.
Systemic treatments for psoriatic disease affect immune function and may raise the risk of infections. Since older persons are at increased risk for infections, the relative safety of these treatments is important to know. This cohort study used population-based health administrative linked data in Ontario between 2002 and 2021. The research involved Ontario residents aged 66 years and older who were newly prescribed their first systemic psoriatic disease medication from April 1, 2002, to December 31, 2020. Data analysis took place between November 2021 and August 2024.
Participants were grouped according to the systemic medication prescribed to them, including:
• Methotrexate
• Other older systemic agents
• Anti-tumor necrosis factor (anti-TNF) biologics
• Other biologics (IL-12, IL-23, IL-17 targeting)
• Tofacitinib
The main exposure was time-varying use of these agents, and the main outcome was time to serious infection, which was hospitalization for any infectious reason through March 2021.
Key Findings
• There were a total of 11,641 patients enrolled, of whom 6,114 (53%) were female and median age 71 years (IQR: 68-76 years).
• There were 1,967 serious infections during a median follow-up of 4.8 years (IQR: 2.3-8.4 years).
Rates of infections per 100 person-years differed by treatment group:
• Methotrexate: 2.7 infections
• Other older systemic therapies: 2.5 infections
• Anti-TNF biologics: 2.2 infections
• Other biologics (IL-12, IL-23, IL-17): 1.4 infections
• Tofacitinib: 8.9 infections
Adjusted relative risk (RR) of serious infections versus non-use of respective treatments:
• Methotrexate: RR = 0.95 (95% CI: 0.85-1.07)
• Other older systemic therapies: RR = 0.92 (95% CI: 0.79-1.07)
• Anti-TNF biologics: RR = 0.87 (95% CI: 0.69-1.10)
• Other biologics (IL-12, IL-23, IL-17): RR = 0.65 (95% CI: 0.48-0.88)
• Tofacitinib: RR = 2.89 (95% CI: 1.14-7.34)
• Other biologics (IL-12, IL-23, IL-17) were associated with a reduced incidence of serious infections, whereas tofacitinib had an increased risk of infections.
The study authors conclude that biologics against IL-12, IL-23, and IL-17 can be a safer choice for elderly patients with psoriatic disease because they are less likely to cause serious infections. Conversely, tofacitinib was associated with a considerably increased risk of infection, necessitating cautious use in clinical practice. These results highlight the value of personalized treatment decisions to reconcile efficacy and safety in elderly patients with psoriatic disease.
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