Ustekinumab Versus Other Biologics in Psoriatic Disease: Which Medications Increase Risk for Infection?

In a recent study, researchers compared ustekinumab versus other biologics and apremilast for risk of serious infection requiring hospitalization among patients with psoriasis (PsO) or psoriatic arthritis (PsA).

They used multiple databases to identify patients who started treatment with adalimumab, apremilast, certolizumab, etanercept, golimumab, ixekizumab, secukinumab, or ustekinumab between 2009 and 2018. The main outcome was serious bacterial, viral, or opportunistic infections. Hazard ratios (HRs) were estimated for each drug versus ustekinumab.

Final analysis included 123,383 patients with PsO/PsA and 117,744 person-years of follow-up. A total of 1,514 serious infections were recorded during the study period; the crude incidence was 1.29 per 100 person-years. Among patients who started ustekinumab during the study period, when implementing propensity score fine stratification and weighting, serious infection rates per 100 person-years ranged from 0.59 to 0.95.

The combined weighted HRs for serious infections, compared against ustekimunab, were: adalimumab, 1.66 (95% confidence interval [CI], 1.34-2.06); apremilast, 1.42 (95% CI, 1.02-1.96); certolizumab, 1.09 (95% CI, 0.68-1.75); etanercept, 1.39 (95% CI, 1.01-1.90); golimumab, 1.74 (95% CI, 1.00-3.03); infliximab, 2.92 (95% CI, 1.80-4.72); ixekizumab, 2.98 (95% CI, 1.20-7.41); and secukinumab, 1.84 (95% CI, 1.24-2.72).

The results of the study were published in Arthritis Care & Research.

“Other biologics and apremilast were associated with 1.4‐ to 3‐times higher risk of hospitalized serious infections in PsO/PsA patients when compared with ustekinumab; such safety profile should be considered when selecting appropriate treatment regimens in patients with PsO/PsA,” the study authors wrote in their conclusion.

In an effectiveness comparison study published last year in JAMA Dermatology, researchers compared secukinumab versus ustekinumab. The study observed that, for both medications, effectiveness was lower in a real-world clinical setting than in a trial setting. Overall, though, secukinumab was more effective than ustekinumab.

“This comparative effectiveness study found that secukinumab resulted in more patients achieving a PASI of 2 or lower after 12 months of therapy compared with ustekinumab in patients with psoriasis. Target trial emulation in this study resulted in regulatory and estimate agreement with the CLEAR randomized clinical trial; further such studies may help fill the evidence gap when comparing other systemic therapies for psoriasis,” the researchers concluded.