Table I.
Rate of infections with systemic immunosuppressive or biologic therapy, or both, for dermatologic indications
| Medication | Dermatologic indication (n) | URI drug/control, No. (%) | Viral infection drug/control No. (%) | Pneumonia drug/control, No. (%) | Infections, overall drug/control, No. (%) | Comments |
|---|---|---|---|---|---|---|
| Etanercept | Psoriasis (n = 583) | 51 (13)/25 (13)∗ ↔ | NR | NR | NR | … |
| Adalimumab | Psoriasis (n = 425) | NR | NR | 0 (0)/0 (0) ↔ | 14 (16.1)/59 (17.5) | … |
| Psoriasis (n = 1212) | 59 (7.2)/14 (3.5) ↑ | NR | NR | 235 (28.9)/89 (22.4) | … | |
| Psoriasis (n = 163) | NR | 0 (0)/1 (1.9) ↔ | NR | 51 (47.7)/23 (43.4) | … | |
| HS (n = 631) | NR | 0 (0)/1 (0.3) ↔ | NR | 79 (25)/96 (30.5)† | … | |
| Infliximab | Psoriasis (n = 129) | 7 (8.3)/2 (4.4) ↑ | NR | NR | NR | At week 26 |
| Psoriasis (n = 378) | 46 (15)/12 (16) ↔ | NR | NR | 125 (42)/30 (40) | … | |
| Psoriasis (n = 835) | 92 (14.7)/29 (14) ↔ | NR | NR | NR | … | |
| PG (n = 30) | NR↔ | 0 (0)/1 (6) | NR | NR | … | |
| HS (n = 33) | 4 (26.7)/5 (27.8) ↔ | 0 (0)/1 (5.6) | NR | NR | … | |
| Certolizumab | Psoriasis (n = 389) | 14 (4.2)/6 (10.5)∗ ↔ | NR | 1 (0.3)/0 (0)∗ | 82 (24.7)/16 (28.1)∗ | Reported as infections and infestations |
| Psoriasis (n = 460) | 24 (7)/5 (5) ↑ | NR | NR | 129 (36)/31 (31)∗,† | … | |
| Psoriasis (n = 175) | 4 (3.4)/4 (6.9)∗ ↔ | NR | NR | 43 (37)/24 (41)∗ | Reported as influenza. Other respiratory morbidities (tonsillitis, nasopharyngitis, rhinitis, bronchitis): 32 (27.4)/19 (32.8) | |
| Ustekinumab | Psoriasis (n = 9882) | 45 mg; 1.40 (1.09-1.81) | NR | NR | 45 mg; 1.09 (0.90-1.32) | Reported as RR by dose; 6 studies included. P > .2 for all data presented. Single study data for 3- and 5-year follow-up was similar |
| 90 mg; 1.02 (0.84-1.24) ↔ | 90 mg; 1.06 (0.93-1.21) | |||||
| Risankizumab | Psoriasis (n = 39) | 3 (10)/1 (13) ↔ | NR | NR | NR | … |
| Psoriasis (n = 171) | NR | NR | NR | NR | … | |
| Psoriasis (n = 997) | 30 (5)/8 (4) ↔ | NR | NR | 131 (22)/26 (13) | Reported as viral URI (other URI 4.7% and 2.0% for risankizumab and placebo, respectively) ↑ | |
| Tildrakizumab | Psoriasis (n = 2862) | 25 (2)/9 (1.9)∗,† ↔ | NR | NR | 3 (0.2)/1 (0.3) | Reported as severe infections requiring intravenous antibiotics |
| Guselkumab | Psoriasis (n = 837) | 25 (7.6)/9 (5.2) ↑ | NR | NR | 85 (25.8)/44 (25.3) | … |
| Psoriasis (n = 992) | 16 (3.2)/10 (4) ↔ | NR | NR | 106 (21.5)/46 (18.5) | … | |
| Secukinumab | Psoriasis (n = 2077) | 39 (2.8)/5 (0.7)† | 10 (0.7)/2 (0.3)† | NR | … | Viral infection with oral herpes |
| Psoriasis (n = 949) | Included in study immediately above | 31 (4.4)/3 (1.2)∗,† ↑ | NR | 378 (53.8)/48 (19.4) | Data included in study immediately above Reported separately due to description of influenza-like illness and overall infections | |
| Ixekizumab | Psoriasis (n = 1224) | 51 (3.5)/12 (3)∗,† ↔ | NR | NR | 381 (26)/74 (21)∗,† | … |
| Brodalumab | Psoriasis (n = 661) | 36 (8.2)/14 (6.4)∗ ↑ | NR | NR | 3 (0.7)/0 (0)∗ | … |
| Psoriasis (n = 195) | 13 (8)/2 (5)∗ ↑ | NR | NR | NR | … | |
| Psoriasis (n = 3089) | 112 (4.5)/40 (6.4)∗,† ↔ | NR | 1 (.04)/0 (0)∗,† ↔ | 11 (0.45)/2 (0.3)∗,† | … | |
| Anakinra | HS (n = 20) | … | NR | NR | 1 (5)/1 (5) | … |
| Omalizumab | Chronic urticaria (n = 322) | 7 (2.9)/7 (8.9) ↔ | NR | MR | 88 (36.2)/30 (38) | Additional outcomes, drug/control, No. (%): Viral URI: 6 (2.5)/1 (1.3); Flu: 10 (4.1)/4 (5.1) |
| Chronic urticaria (n = 335) | 18 (7.1)/2 (2.4) ↑ | NR | NR | 93 (36.9)/25 (30.1) | … | |
| Chronic urticaria (n = 318) | 7 (2.9)/3 (3.8) ↔ | NR | NR | 68 (28.6)/22 (27.5) | … | |
| Dupilumab | Atopic dermatitis (n = 2932) | 19 (1.0)/16 (1.5)∗ ↔ | 100 (5.4)/51 (4.7)∗ | NR | 739 (40.1)/453 (41.5)∗ | … |
| Rituximab | Pemphigus vulgaris (n = 91) | NR | NR | 3 (11)/1 (2) ↑ | NR | Control: oral prednisone (1-1.5 mg/kg/d) |
| Cyclosporine | Psoriasis (n = 217) | 10 (4.6%) ↑ | 4 (1.8) | NR | NR | Dose escalation study. No placebo control. |
| PG (n = 121) | NR | NR | NR | 4 (7)/5 (9) ↔ | Control: oral prednisolone (0.75 mg/kg/d) | |
| Azathioprine | Atopic dermatitis (n = 37) | 5 (13.5)/2 (5) ↑ | NR | NR | 1 (2.7)/1 (2.7) | … |
| Atopic dermatitis (n = 63) | 2 (5)/1 (5) ↔ | NR | NR | 2 (5)/0 (0) | Higher rates of lower respiratory infection in the treatment arm | |
| Tofacitinib | Psoriasis (n = 1106) | 10 (1.5)/0 (0) ↑ | NR | NR | 134 (20.3)/20 (18.7) | … |
| Methotrexate | Psoriasis, psoriatic arthritis (n = 221) | 31 (28.4)/25 (22.3) ↑ | NR | NR | NR | … |
HS, Hidradenitis suppurativa; NR, none reported; PG, pyoderma gangrenosum; RR, relative risk; URI, upper respiratory infection.
Control group is placebo unless stated otherwise in comments. ↔Suggests no increased URI. ↑Suggests increased URI.
∗
Combined doses reported as mean.
†
Data collected from 2 phase II-III trials and reported as mean.