{"id":21629,"date":"2025-03-19T10:06:44","date_gmt":"2025-03-19T14:06:44","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=21629"},"modified":"2025-03-20T10:23:35","modified_gmt":"2025-03-20T14:23:35","slug":"systemic-therapies-for-psoriatic-disease-and-serious-infections-in-older-adults","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/systemic-therapies-for-psoriatic-disease-and-serious-infections-in-older-adults\/","title":{"rendered":"Systemic therapies for psoriatic disease and serious infections in older adults"},"content":{"rendered":"<p><strong>Importance<\/strong> \u2014 Systemic treatments for psoriatic disease affect the immune system and may increase infection risk. Older adults are at high risk for infection, and the relative safety of systemic treatments for them is unknown.<\/p>\n<p><strong>Objective<\/strong> \u2014 To evaluate the association of systemic treatments for psoriatic disease with rates of serious infection among older adults.<\/p>\n<p><strong>Design, setting, and participants<\/strong> \u2014 This cohort study used linked population-based health administrative data from 2002 to 2021 in Ontario, Canada. Participants included Ontario residents 66 years and older with psoriatic disease who were dispensed their first systemic medication between April 1, 2002, and December 31, 2020. Data were analyzed between November 2021 and August 2024.<\/p>\n<p><strong>Exposure<\/strong> \u2014 Time-varying use of systemic medications categorized as (1) methotrexate; (2) other older systemic medications; (3) anti\u2013tumor necrosis factor (anti-TNF) biologics; (4) other biologics (targeting interleukin [IL]-12, IL-23, and IL-17); and (5) tofacitinib.<\/p>\n<p><strong>Main outcomes and measures<\/strong> \u2014 The main outcome was time to serious infection, defined as hospitalization for any infectious cause occurring up to March 2021. Multivariable Andersen-Gill recurrent event regression was used to estimate the association between each medication category and serious infection rates. The relative rates (RRs) of serious infection with 95% CIs for time actively using each medication category vs time not using that medication category were calculated.<\/p>\n<p><strong>Results<\/strong> \u2014 Of 11\u202f641 new users of systemic therapy, 6114 (53%) were female, and the median (IQR) age was 71 (68-76) years. There were 1967 serious infections during a median (IQR) of 4.8 (2.3-8.4) years of follow-up. There were 2.7 serious infections per 100 person-years using methotrexate, 2.5 per 100 person-years using other older systemic drugs, 2.2 per 100 person-years using anti-TNF biologics, 1.4 per 100 person-years using other biologics, and 8.9 per 100 person-years using tofacitinib. In the multivariable-adjusted model, methotrexate (RR, 0.95 [95% CI, 0.85-1.07]), other 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 to person-time not using those respective medications. Other biologics (RR, 0.65 [95% CI, 0.48-0.88]) were associated with lower rates of serious infection, whereas tofacitinib (RR, 2.89 [95% CI, 1.14-7.34]) was associated with higher rates of serious infection.<\/p>\n<p><strong>Conclusions and relevance<\/strong> \u2014 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.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Importance \u2014 Systemic treatments for psoriatic disease affect the immune system and may increase infection risk. Older adults are at high risk for infection, and the relative safety of systemic treatments for them is unknown. Objective \u2014 To evaluate the association of systemic treatments for psoriatic disease with rates of serious infection among older adults. [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[17,56,44],"migration-helper-qa-sample-set":[],"class_list":["post-21629","journal_article","type-journal_article","status-publish","hentry","topic-older-people","topic-pharmacoepidemiology-and-drug-safety","topic-skin-diseases-and-disorders"],"acf":{"citation":"Drucker AM, Sutradhar R, Ling V, Gatley JM, Eder L, Fahim C, Fralick M, Gomes T, Li P, MacDougall S, Manolson M, Rochon PA, Tadrous M. <em>JAMA Dermatol<\/em>. 2025; Mar 19 [Epub ahead of print].","source_url":"https:\/\/doi.org\/10.1001\/jamadermatol.2025.0144","ices_scientist":[1218,1370,1252,1340,1108],"site":[6733],"research_program":[6746],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Systemic therapies for psoriatic disease and serious infections in older adults<\/title>\n<meta name=\"description\" content=\"Importance \u2014 Systemic treatments for psoriatic disease affect the immune system and may increase infection risk. 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