Safety observations in 12095 patients with psoriasis enrolled in an international registry (PSOLAR): experience with infliximab and other systemic and biologic therapies.

Abstract

BACKGROUND:

Long-term data are essential to assess the safety of biologic agents for the treatment of psoriasis.

OBJECTIVE:

To evaluate the incidence of adverse events of interest (AEIs), including all-cause mortality, major adverse cardiovascular events (MACE), malignancy (excluding nonmelanoma skin cancer), and serious infections (SI), in patients treated for psoriasis in clinical practice settings.

METHODS:

PSOLAR is a large, ongoing, observational study of patients receiving, or eligible to receive, biologic or systemic therapy for psoriasis. Cumulative incidence rates of AEIs per 100 patient-years (PY) are reported across treatment cohorts: (1) infliximab, (2) ustekinumab, (3) other biologics (eg, adalimumab and etanercept), and (4) non-biologic agents. Significant predictors of each AEI were identified using Cox proportional hazards regression methodology.

RESULTS:

PSOLAR is now fully enrolled at 12095 patients followed for 31818PY. The cumulative rate was 0.46/100PY for death, 0.36/100PY for MACE, 0.68/100PY for malignancy, and 1.50/100PY for SI. Increasing age was a significant predictor of all AEIs. A history of cardiovascular disease, malignancy, and significant infection was associated with a higher risk of developing MACE, malignancy, and SI, respectively. Exposure to infliximab (Hazard Ratio [HR]=3.101, P<0.001) and exposure to other biologics (HR=1.736, P<0.001) were significant predictors of SI. Use of immunomodulators (HR=1.954, P=0.005) was a significant predictor of MACE. Compared with non-biologic therapy, the use of biologic agents was not a significant predictor of death, MACE, or malignancy.

CONCLUSIONS:

Based on PSOLAR data through 2013, no new safety concerns were observed with infliximab for all-cause mortality, MACE, or malignancy; the data suggest that infliximab was associated with serious infections.

• Authors: Alice B Gottlieb, Robert E Kalb, Richard G Langley, Gerald G Krueger, Elke M G J de Jong, Lynn Guenther, Kavitha Goyal, Steven Fakharzadeh, Marc Chevrier, Stephen Calabro, Wayne Langholff, Alan Menter
• Journal: Journal of drugs in dermatology : JDD (J Drugs Dermatol) Vol. 13 Issue 12 Pg. 1441-8 (Dec 2014) ISSN: 1545-9616 [Print] United States
• PMID: 25607786 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Immunologic Factors
• Infliximab
• Ustekinumab
• Adalimumab

Topics

• Adalimumab
• Adult
• Aged
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Antibodies, Monoclonal, Humanized (adverse effects, therapeutic use)
• Biological Therapy (adverse effects, methods)
• Female
• Humans
• Immunologic Factors (adverse effects, therapeutic use)
• Infliximab
• Male
• Middle Aged
• Proportional Hazards Models
• Psoriasis (drug therapy)
• Registries
• Risk Factors
• Time Factors
• Ustekinumab