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Meta-Analysis
. 2016 Aug;136(8):1584-1591.
doi: 10.1016/j.jid.2016.03.035. Epub 2016 Apr 13.

Risk of Serious Infections in Patients with Psoriasis on Biologic Therapies: A Systematic Review and Meta-Analysis

Zenas Z N Yiu  1 , Lesley S Exton  2 , Zarif Jabbar-Lopez  3 , M Firouz Mohd Mustapa  2 , Eleanor J Samarasekera  4 , A David Burden  5 , Ruth Murphy  6 , Caroline M Owen  7 , Richard Parslew  8 , Vanessa Venning  9 , Darren M Ashcroft  10 , Christopher E M Griffiths  11 , Catherine H Smith  12 , Richard B Warren  13
Affiliations
Meta-Analysis

Risk of Serious Infections in Patients with Psoriasis on Biologic Therapies: A Systematic Review and Meta-Analysis

Zenas Z N Yiu et al. J Invest Dermatol. 2016 Aug.

Abstract

A comprehensive evaluation of the risk of serious infections in biologic therapies for psoriasis is lacking. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and prospective cohort studies reporting serious infections in people taking any licensed biologic therapy for psoriasis compared with those taking placebo, nonbiologic therapy, or other biologic therapies. The quality of the studies was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. No significant heterogeneity was detected in data from 32 RCTs (n = 13,359 participants) and one cohort study (n = 4,993 participants). In adults, low- to very-low-quality RCT data showed no significant difference between any biologic therapy and placebo at weeks 12-16 (overall pooled Peto odds ratio = 0.71, 95% confidence interval = 0.36-1.41) and weeks 20-30 (odds ratio = 2.27, 95% confidence interval = 0.45-11.49). No significant differences were found in any of the other comparisons in underpowered RCT data. Prospective cohort study data of low quality suggests that only adalimumab (adjusted hazard ratio [adjHR] = 2.52, 95% confidence interval = 1.47-4.32) was associated with a significantly higher risk of serious infection compared with retinoid and/or phototherapy in adults. No association between biologic therapies and serious infections in patients with psoriasis who were eligible for RCTs was detected. Further observational studies are needed to inform the uncertainty around this risk in the real world.

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Figures

Figure 1
Figure 1
Flow diagram showing the identification of literature in the PRISMA statement format.
Figure 2
Figure 2
Forest plot for dose-independent comparison between biologic therapies and placebo. Serious infection at week 12–16 for adults (randomized controlled trials). CI, confidence interval.
Figure 3
Figure 3
Forest plot for dose-independent comparison between biologic therapies and retinoid therapy/phototherapy. Serious infection in adults (cohort studies). CI, confidence interval; IV, inverse variance; SE, standard error.
See this image and copyright information in PMC

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