Infliximab is associated with an increased risk of serious infection in patients with psoriasis in the UK and Republic of Ireland: results from the British Association of Dermatologists Biologic Interventions Register (BADBIR)

Background Patients with psoriasis and clinicians are concerned that infliximab may be associated with a risk of serious infections. Objectives To compare the risk of serious infections associated with infliximab in patients with chronic plaque psoriasis against a cohort on nonbiologic systemic therapies. Methods A prospective cohort study was performed using data from the British Association of Dermatologists Biologic Interventions Register (BADBIR). Infliximab was compared with nonbiologic systemic therapies, inclusive of any exposure to methotrexate, ciclosporin, acitretin, fumaric acid esters, psoralen-ultraviolet A or hydroxycarbamide. Serious infections were those associated with hospitalization, the use of intravenous antimicrobial therapy and/or those that led to death. Propensity score inverse probability treatment weights were used to adjust for potential confounding from a priori identified covariates. Cox proportional hazards models were calculated to obtain hazard ratios (HRs). Results In total, 3843 participants were included for analysis up to October 2016. The incidence rates were significantly higher in the infliximab cohort (47 center dot 8 per 1000 person-years) [95% confidence interval (CI) 35 center dot 7-64 center dot 0], compared with 14 center dot 2 per 1000 person-years (95% CI 11 center dot 5-17 center dot 4) in the nonbiologic systemic cohort. Infliximab was associated with an overall increase in the risk of serious infection compared with nonbiologics [adjusted HR (adjHR) 1 center dot 95, 95% CI 1 center dot 01-3 center dot 75] and methotrexate only (adjHR 2 center dot 96, 95% CI 1 center dot 58-5 center dot 57) and a higher risk of serious infection in the first 6 months of therapy (adjHR 3 center dot 49, 95% CI 1 center dot 14-10 center dot 70). Conclusions Infliximab is associated with an increased risk of serious infections compared with nonbiologic systemic therapies in patients with psoriasis in the U.K. and the Republic of Ireland.