Treatment Type Does not Increase Serious Infection Risk in Pediatric Psoriasis
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Patients with pediatric psoriasis who were treated with biologics did not have a greater risk for serious infection than those treated with nonbiologics or phototherapy, according to a study.
“Systemic medications have greatly improved outcomes and quality of life in pediatric psoriasis; however, the associated risk of serious infections is unclear. This real-world evidence study sought to provide information about the comparative safety of systemic medications in pediatric patients with psoriasis,” study author Maria C. Schneeweiss, MD, postdoctoral research fellow at Brigham and Women’s Hospital and Harvard Medical School, told Healio in email correspondence.
The study used insurance claims data to identify 57,323 children with psoriasis and compared the frequency of serious infections in those taking biologics, systemic nonbiologics and phototherapy.
Four cohorts were identified. Cohort 1 included 722 new users of biologic agents vs. 988 new users of nonbiologic immunomodulatory agents; cohort 2 included 703 new users of biologic agents vs. 2,657 patients newly treated with phototherapy; cohort 3 included 952 new nonbiologic immunomodulatory agent users vs. 2,645 patients newly treated with phototherapy; and cohort 4 included 53,999 pediatric patients with psoriasis vs. 133,429 patients without psoriasis.
According to the study, after 1:1 propensity score matching, cohort 1 included 669 pairs of patients starting biologic agents vs. nonbiologic immunomodulators; cohort 2 included 681 pairs of patients starting biologic agents vs. phototherapy; cohort 3 included 909 pairs of patients starting nonbiologic immunomodulators vs. phototherapy; and cohort 4 had 49,809 pairs of patients with vs. without psoriasis.
In biologic initiators, the 6-month risk for serious infections was 2.99 per 1,000 person-years compared with 4.48 per 1,000 person-years for nonbiologic immunomodulator initiators, which resulted in a relative risk of 0.67 (95% CI, 0.11-3.98). A relative risk of 1.50 (95% CI, 0.25-8.95) was observed when comparing biologic initiators with phototherapy and 5.00 (95% CI, 0.59-42.71) in comparing nonbiologics with phototherapy.
Children with psoriasis had almost double the risk for infection compared with those without psoriasis (RR = 1.84; 95% CI, 1.15-1.97).
“Overall, the rate of serious infections was low among pediatric patients treated with immunomodulatory medications for psoriasis, which is reassuring of the safety of these agents in pediatric psoriasis,” Schneeweiss said. “This study hopefully aids clinicians and families in shared decision-making to choose the most appropriate treatment option for each individual case. In an era of target to treat, our pediatric patients suffering from psoriasis should be offered that same level of disease control as all other psoriasis patients and not be restricted from targeted, highly effective therapy as appropriate to each individual case.” – by Rebecca L. Forand
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