Infecciones en pacientes con psoriasis pediatricos...

ublished in Dermatology

Journal Scan / Research · March 19, 2020

Serious Infection Risk in Children With Psoriasis on Systemic Treatment

Journal of the American Academy of Dermatology

Contributions from 

 

Robert T Brodell MD, FAAD

It is always nice to have one more piece of evidence to support the concept that modern psoriasis treatments block only  "a little sliver" of immunity....and risks of significant infection are low and not much different than would be experienced by a patient taking a placebo!

Abstract

BACKGROUND

Psoriasis (PsO) is increasingly treated with systemic medications, yet their safety is not well characterized in children.

OBJECTIVE

We sought to estimate the 6-month risk of serious infections in children with PsO treated with biologics, systemic non-biologics and phototherapy.

METHODS

Using insurance claims data, we identified children <18 years with PsO and compared the frequency of serious infections in those initiating biologics, systemic non-biologics, and phototherapy. Relative risks (RR) were estimated before and after 1:1 propensity-score matching.

RESULTS

Among 57,323 children with PsO, the 6-month risk of infection was 4.2 per 1,000 patient-years in 722 biologic initiators, 5.1 in 988 systemic non-biologic initiators, and 1.1 in 2,657 phototherapy initiators. The RR of infection in biologics vs. non-biologics was 0.67 (0.11, 3.98), in biologics vs. phototherapy was 1.50 (0.25, 8.95) and in non-biologics vs. phototherapy was 5.00 (0.59, 42.71). The background risk of infection in children with PsO was 1 per 1,000, almost double the risk compared to children without PsO (RR=1.84; 1.15, 1.97).

CONCLUSIONS

We found no meaningful difference in infection risk between biologics vs. non-biologics, and no robust difference between systemic users vs. phototherapy. Independent of treatment, children with PsO had a higher risk of infection than those without PsO.

Journal of the American Academy of Dermatology

Serious Infection Risk in Children With Psoriasis on Systemic Treatment: A Propensity Score Matched Population-Based Study

J Am Acad Dermatol 2020 Mar 03;[EPub Ahead of Print], MC Schneeweiss, JT Huang, R Wyss, S Schneeweiss, JF Merola