Comparison of Psoriatic Disease Systemic Therapy, Serious Infection Rates in Older Adults

To explore the association of different systemic medication classes with serious infections among older patients with psoriasis and psoriatic arthritis, a group of researchers conducted a study in Ontario, Canada, comparing interleukin (IL) biologics (IL-12, -23, and -17), methotrexate, older systemic medications, anti–tumor necrosis factor (anti-TNF) biologics, and tofacitinib. Results were published in JAMA Dermatology.

To assess how psoriatic disease medications affect the immune system and increase infection risk, the researchers used linked population-based health administrative data from 2002 to 2021 of Ontario residents aged 66 years or older with psoriatic disease. The main outcome was time to serious infection as defined by hospitalization for any infection occurring up to March 2021.

Multivariable Andersen-Gill recurrent event regression was used to estimate the link between medication category and serious infection rate. Relative rates (RRs) of serious infection were calculated using duration of medication actively used for each category versus time not used.

Of 11,641 participants, 6,114 (53%) were women; the median age was 71 years (interquartile range [IQR], 68-76). There were 1,967 serious infections during a median of 4.8 years (IQR, 2.3-8.4) of follow-up.

The rates of serious infection with each medication category were:

• Methotrexate: 2.7 serious infections per 100 person-years (PY)
• Older systemic drugs: 2.5 per PY
• Anti-TNF biologics: 2.2 per PY
• IL biologics: 1.4 per PY
• Tofacitinib: 8.9 per PY

According to the multivariable-adjusted model, methotrexate (RR, 0.95; 95% CI, 0.85-1.07), older systemic medications (RR, 0.92; 95% CI, 0.79-1.07), and anti-TNF biologics (RR, 0.87; 95% CI, 0.69-1.10) were not associated with serious infection compared with time that the respective medication was not used. Tofacitinib (RR, 2.89; 95% CI, 1.14-7.34) was associated with higher rates of serious infection.

The researchers concluded that “In this cohort study, biologics targeting IL-12, IL-23, or IL-17 were associated with a lower rate of serious infection among older adults with psoriatic disease. These biologics may have important safety benefits for older adults with higher infection risk.”

Reference

Drucker AM, Sutradhar R, Ling V, et al. Systemic therapies for psoriatic disease and serious infections in older adults. JAMA Dermatol. Published online March 19, 2025. doi:10.1001/jamadermatol.2025.0144