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Some systemic psoriasis treatments may be associated with UTI risk

The use of cyclosporine, infliximab and anti-IL17 in the treatment of psoriasis is associated with a higher risk for symptomatic urinary tract infection in women, according to a 10-year observational study.

“Our primary objective was to describe the rates of clinical bacterial UTI in psoriasis patients undergoing systemic treatment compared to those being treated with methotrexate,” Antonio Sahuquillo-Torralba, MD, and colleagues wrote in a research letter accepted by Journal of the American Academy of Dermatology.

Data were collected from 3,013 patients with psoriasis in 16 hospitals in Spain who were exposed to systemic drugs between October 2008 and November 2018. Researchers estimated the crude rates of symptomatic bacterial UTIs in patients receiving systemic drugs compared with those treated with methotrexate. Incidences of bacterial UTIs were recorded and classified as afebrile or febrile UTI.

Adjusted rate ratios (aRR) were obtained based on gender, treatment order, diabetes status, age and propensity score for each drug. Researchers analyzed all anti-IL17 drugs as a group due to a small sample size.

Of the 19 UTIs reported by patients receiving methotrexate, three (16%) were serious. In patients exposed to biologics, five of 91 UTIs (5%) were serious. The aRR of UTIs between biologics and methotrexate was 1.01, demonstrating no difference in the risk for serious UTIs between treatment groups.

When gender was considered, aRR showed increased risks for nonserious UTIs in women treated with cyclosporine, infliximab and anti-IL17, with decreased risks for acitretin.

“Given the increased risk shown by our results (approximately 20 extra cases per 1,000 person-years), an appropriate strategy for women receiving these drugs should be devised, instructing them about warning signs,” Sahuquillo-Torralba and colleagues wrote.

Researchers noted a limitation of the study was the short period of exposure to anti-IL17 and the evaluation of these drugs as one group. “The increased risks detected in this study could be due to chance or selection bias and should be confirmed or disputed by other studies,” they wrote. – by Julia Lowndes

Disclosures: Sahuquillo-Torralba reports serving as a consultant and/or paid speaker for and/or participating in clinical trials sponsored by companies that manufacture drugs used for the treatment of psoriasis, including AbbVie, Celgene, Janssen-Cilag, Leo Pharma, Lilly, Novartis and Pfizer. Please see the study for all other authors’ relevant financial disclosures.