Infection risk among psoriasis biologic-new users: A cohort study on the French National Health Data System

The infection risks of recent biologics for psoriasis remain insufficiently studied.

To simultaneously assess inpatient- and outpatient-managed infection risks of biologics in psoriasis.

Using the French National Health Data System (2013-2022), we conducted a cohort study of 39,669 adults with psoriasis who were new users of biologics. Biologics were compared regarding (i) time to hospitalization for infection, (ii) time to first outpatient anti-infective dispensation, and (iii) proportion of days covered by anti-infectives over 2 years.

During biologic exposure, inpatient-managed infections occurred at 27.1 per 1000 person-years, and median systemic anti-infective coverage was low (5.5%; 95% CI: 2.6-11.5). Using the most frequently prescribed biologic, adalimumab, as reference: (i) inpatient-managed infection risk was lower with ustekinumab, secukinumab, and risankizumab; (ii) first antibacterial use was higher with certolizumab and lower with ustekinumab, guselkumab, and risankizumab; and (iii) antibacterial coverage was lower with ustekinumab, secukinumab, ixekizumab, risankizumab, and tildrakizumab; higher antimycotic coverage was observed with interleukin-17i biologics.

Claims data lacks clinical information and limits our assessment to systemic anti-infectives.

Biologics are associated with low overall infection risks. Among biologics, ustekinumab and interleukin-23 inhibitors show the lowest overall risk (time to the first inpatient/outpatient event).