Table 3. Analysis of Pooled Hazard Risk of Serious Infection in Patients With Psoriasis Receiving Systemic Medications Compared With Methotrexate.
| Exposure | Reference Group (MTX), No. | Exposure Group, No. | Pooled HR (95% CI)b | P Value for Test for Overall Effect | ||
|---|---|---|---|---|---|---|
| Pooled Patients | Pooled Eventsa | Pooled Patients | Events | |||
| Acitretin | ||||||
| Overall serious infection | 30 983 | 385 | 10 182 | 111 | 1.09 (0.83-1.44) | .55 |
| Bacteremia/sepsis | 88 | 23 | 0.93 (0.51-1.70) | .82 | ||
| Cellulitis/soft-tissue infection | 110 | 53 | 1.76 (1.11-2.80) | .02 | ||
| Endocarditis | 0 | 0 | NAc | NAc | ||
| Meningitis/encephalitis | 8 | 1 | NAc | NAc | ||
| Pneumonia | 168 | 36 | 0.85 (0.54-1.35) | .50 | ||
| Pyelonephritis | 12 | 2 | NAc | NAc | ||
| Septic arthritis/osteomyelitis | 12 | 2 | 1.46 (0.18-11.56) | .73 | ||
| Adalimumab | ||||||
| Overall serious infection | 29 079 | 341 | 25 093 | 276 | 1.08 (0.88-1.33) | .47 |
| Bacteremia/sepsis | 78 | 55 | 1.06 (0.66-1.68) | .82 | ||
| Cellulitis/soft-tissue infection | 97 | 117 | 1.34 (0.95-1.89) | .10 | ||
| Endocarditis | 0 | 0 | NAc | NAc | ||
| Meningitis/encephalitis | 6 | 2 | 0.78 (0.10-6.28) | .83 | ||
| Pneumonia | 151 | 98 | 0.94 (0.68-1.31) | .72 | ||
| Pyelonephritis | 9 | 8 | 1.11 (0.27-4.51) | .89 | ||
| Septic arthritis/osteomyelitis | 13 | 8 | 0.73 (0.25-2.19) | .58 | ||
| Apremilast | ||||||
| Overall serious infection | 32 370 | 422 | 6099 | 15 | 0.50 (0.26-0.94) | .03 |
| Bacteremia/sepsis | 94 | 5 | 0.87 (0.26-2.90) | .83 | ||
| Cellulitis/soft-tissue infection | 123 | 6 | 0.51 (0.18-1.42) | .20 | ||
| Endocarditis | 0 | 1 | NAc | NAc | ||
| Meningitis/encephalitis | 8 | 0 | NAc | NAc | ||
| Pneumonia | 186 | 5 | 0.42 (0.14-1.22) | .12 | ||
| Pyelonephritis | 12 | 0 | NAc | NAc | ||
| Septic arthritis/osteomyelitis | 13 | 0 | NAc | NAc | ||
| Etanercept | ||||||
| Overall serious infection | 29 353 | 342 | 23 893 | 236 | 0.75 (0.61-0.93) | .01 |
| Bacteremia/sepsis | 78 | 37 | 0.51 (0.32-0.82) | .01 | ||
| Cellulitis/soft-tissue infection | 93 | 106 | 1.16 (0.82-1.65) | .41 | ||
| Endocarditis | 0 | 3 | NAc | NAc | ||
| Meningitis/encephalitis | 8 | 0 | NAc | NAc | ||
| Pneumonia | 151 | 98 | 0.94 (0.68-1.31) | .72 | ||
| Pyelonephritis | 9 | 6 | 0.68 (0.20-2.34) | .55 | ||
| Septic arthritis/osteomyelitis | 10 | 13 | 1.61 (0.36-7.16) | .54 | ||
| Infliximab | ||||||
| Overall serious infection | 32 020 | 385 | 1435 | 26 | 1.47 (0.75-2.87) | .26 |
| Bacteremia/sepsis | 89 | 4 | 1.30 (0.19-8.63) | .80 | ||
| Cellulitis/soft-tissue infection | 107 | 10 | 1.76 (0.55-5.63) | .35 | ||
| Endocarditis | 0 | 0 | NAc | NAc | ||
| Meningitis/encephalitis | 7 | 1 | NAc | NAc | ||
| Pneumonia | 170 | 8 | 0.80 (0.29-2.24) | .68 | ||
| Pyelonephritis | 9 | 6 | 0.68 (0.20-2.34) | .55 | ||
| Septic arthritis/osteomyelitis | 12 | 1 | NAc | NAc | ||
| Ustekinumab | ||||||
| Overall serious infection | 31 723 | 413 | 11 926 | 77 | 0.65 (0.47-0.89) | .01 |
| Bacteremia/sepsis | 92 | 16 | 0.83 (0.39-1.73) | .64 | ||
| Cellulitis/soft-tissue infection | 121 | 31 | 0.87 (0.51-1.48) | .60 | ||
| Endocarditis | 0 | 0 | NAc | NAc | ||
| Meningitis/encephalitis | 8 | 0 | NAc | NAc | ||
| Pneumonia | 181 | 28 | 0.53 (0.32-0.88) | .01 | ||
| Pyelonephritis | 12 | 3 | 1.32 (0.20-8.78) | .79 | ||
| Septic arthritis/osteomyelitis | 13 | 2 | 0.51 (0.08-3.52) | .50 | ||
Abbreviations: HR, hazard ratio; MTX, methotrexate; NA, not applicable.
a
The sum of events in the subanalyses of serious infections may be greater than the number of events in the overall serious infection analysis if a patient experienced more than 1 serious infectious event.
b
Adjusted for 20% overlap of patients between United Optum Clinformatics Data Mart and Truven MarketScan.
c
Pooled HRs not calculated when HR not calculated in either Optum or MarketScan owing to zero events in exposure or reference groups.