TY - JOUR
T1 - Serious infection risk in children with psoriasis on systemic treatment
T2 - A propensity score-matched population-based study
AU - Schneeweiss, Maria C.
AU - Huang, Jennifer T.
AU - Wyss, Richard
AU - Schneeweiss, Sebastian
AU - Merola, Joseph F.
N1 - Funding Information:
Funding sources: This study was supported by the Brigham and Women's Hospital Department of Dermatology.Conflicts of interest: Dr S. Schneeweiss is the principal investigator of investigator-initiated grants to the Brigham and Women's Hospital from Bayer, Vertex, and Boehringer Ingelheim unrelated to the topic of this study, and was a consultant to WHISCON and is a consultant to Aetion, a software manufacturer of which he owns equity. His interests were declared, reviewed, and approved by the Brigham and Women's Hospital and Partners HealthCare System in accordance with their institutional compliance policies. Dr Merola served as a consultant and/or investigator for Biogen IDEC, AbbVie, Amgen, Eli Lilly, Novartis, Pfizer, Janssen, UCB, Celgene, Sanofi Regeneron, Merck, and GSK. Drs M. Schneeweiss, Huang, and Wyss have no conflicts of interest to declare.
Funding Information:
Funding sources: This study was supported by the Brigham and Women's Hospital Department of Dermatology.
Publisher Copyright:
© 2020 American Academy of Dermatology, Inc.
PY - 2020/6
Y1 - 2020/6
N2 - Background: Psoriasis is increasingly treated with systemic medications, yet their safety is not well characterized in children. Objective: We sought to estimate the 6-month risk of serious infections in children with psoriasis treated with biologics, systemic nonbiologics, and phototherapy. Methods: Using insurance claims data, we identified children aged <18 years with psoriasis and compared the frequency of serious infections in those initiating biologics, systemic nonbiologics, and phototherapy. Relative risks were estimated before and after 1:1 propensity score matching. Results: Among 57,323 children with psoriasis, the 6-month risk of infection was 4.2 per 1000 patient-years in 722 biologic initiators, 5.1 in 988 systemic nonbiologic initiators, and 1.1 in 2657 phototherapy initiators. The relative risk (95% confidence interval) of infection in biologics vs nonbiologics was 0.67 (0.11-3.98), in biologics vs phototherapy was 1.50 (0.25-8.95), and in nonbiologics vs phototherapy was 5.00 (0.59-42.71). The background risk of infection in children with psoriasis was 1 per 1000, almost double the risk compared with children without psoriasis (relative risk, 1.84; 95% confidence interval, 1.15-1.97). Conclusions: We found no meaningful difference in infection risk between biologics vs nonbiologics and no robust difference between systemic users vs phototherapy. Independent of treatment, children with psoriasis had a higher risk of infection than those without psoriasis.
AB - Background: Psoriasis is increasingly treated with systemic medications, yet their safety is not well characterized in children. Objective: We sought to estimate the 6-month risk of serious infections in children with psoriasis treated with biologics, systemic nonbiologics, and phototherapy. Methods: Using insurance claims data, we identified children aged <18 years with psoriasis and compared the frequency of serious infections in those initiating biologics, systemic nonbiologics, and phototherapy. Relative risks were estimated before and after 1:1 propensity score matching. Results: Among 57,323 children with psoriasis, the 6-month risk of infection was 4.2 per 1000 patient-years in 722 biologic initiators, 5.1 in 988 systemic nonbiologic initiators, and 1.1 in 2657 phototherapy initiators. The relative risk (95% confidence interval) of infection in biologics vs nonbiologics was 0.67 (0.11-3.98), in biologics vs phototherapy was 1.50 (0.25-8.95), and in nonbiologics vs phototherapy was 5.00 (0.59-42.71). The background risk of infection in children with psoriasis was 1 per 1000, almost double the risk compared with children without psoriasis (relative risk, 1.84; 95% confidence interval, 1.15-1.97). Conclusions: We found no meaningful difference in infection risk between biologics vs nonbiologics and no robust difference between systemic users vs phototherapy. Independent of treatment, children with psoriasis had a higher risk of infection than those without psoriasis.
KW - epidemiology
KW - immunomodulating drugs
KW - opportunistic infections
KW - pediatrics
KW - psoriasis
KW - safety
KW - serious bacterial infections
KW - systemic medications
UR - http://www.scopus.com/inward/record.url?scp=85083297450&partnerID=8YFLogxK
U2 - 10.1016/j.jaad.2020.02.065
DO - 10.1016/j.jaad.2020.02.065
M3 - Article
C2 - 32142748
AN - SCOPUS:85083297450
SN - 0190-9622
VL - 82
SP - 1337
EP - 1345
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 6
ER -