A patient at the dermatology clinic at Salford Royal with Dr Elise Kleyn

Psoriasis research brings good news on risk of infection

Researchers have found no increased risk of serious infection when comparing biologic and non-biologic psoriasis treatments.

Psoriasis is a common skin condition affecting up to 3% of the population of the United Kingdom and Ireland. Although there is currently no cure for psoriasis, many people can live well with psoriasis if they have the right treatment and advice.

Moderate to severe psoriasis is increasingly managed by biologic, immune-modulating therapies. Sometimes patients have side-effects from biologics and one of the reasons for them discontinuing treatment is infection. Some of these infections can be serious, and associated with severe illness or even death. Patients and their doctors are often concerned about this risk, leading to the avoidance of what could potentially be life-changing treatment.

Keen to investigate the risk of serious infections, dermatology researchers from the NIHR Manchester BRC set out to determine whether three of the recommended biologic therapies (etanercept, adalimumab or ustekinumab) for psoriasis elevate the risk of serious infection above that for non-biologic, conventional tablet treatments.

The research team based at Salford Royal NHS Foundation Trust and The University of Manchester used a large, national, prospective psoriasis registry – the British Association of Dermatologists Biologic Interventions Register (BADBIR) for the study.  In total, more than 9,000 patients were assessed in different groups depending on their biologic or non-biologic treatment, making it the largest study of its kind. The team analysed baseline and follow-up information from patients on the register, which included specific information about serious infections.

The findings, published in the Journal of Investigative Dermatology, found no significant increases in the risk of serious infection for the three biologic therapies as compared to non-biologic therapies. This means the risk of serious infection should not be a primary concern for patients and clinicians when deciding between these treatments or non-biologic treatment.

Dr Zenas Yiu, NIHR Doctoral Research Fellow, said: “Our research reinforces the British Association for Dermatologists guideline for biologic therapies in psoriasis. There is often a perception that less effective treatments, such as etanercept (a second-line biologic), may have a lower risk of serious infection than other more effective biologics. We have shown that all three recommended biologics carry no significant increase in risk of serious infection over traditional tablet treatments. Patients can be reassured that choosing a more effective treatment for their psoriasis does not expose them to a higher risk of getting serious infections. ”