Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2025 May 1;161(5):490-497.
doi: 10.1001/jamadermatol.2025.0144.

Systemic Therapies for Psoriatic Disease and Serious Infections in Older Adults

Aaron M Drucker  1   2   3   4 , Rinku Sutradhar  4   5 , Vicki Ling  4 , Jodi M Gatley  4 , Lihi Eder  1   2   3 , Christine Fahim  6 , Michael Fralick  1   7 , Tara Gomes  4   6   8 , Ping Li  4 , Sue MacDougall  9 , Morris Manolson  10 , Paula A Rochon  1   2   3   4   11 , Mina Tadrous  3   4   8
Affiliations
Comment

Systemic Therapies for Psoriatic Disease and Serious Infections in Older Adults

Aaron M Drucker et al. JAMA Dermatol. .

Abstract

Importance: Systemic treatments for psoriatic disease affect the immune system and may increase infection risk. Older adults are at high risk for infection, and the relative safety of systemic treatments for them is unknown.

Objective: To evaluate the association of systemic treatments for psoriatic disease with rates of serious infection among older adults.

Design, setting, and participants: This cohort study used linked population-based health administrative data from 2002 to 2021 in Ontario, Canada. Participants included Ontario residents 66 years and older with psoriatic disease who were dispensed their first systemic medication between April 1, 2002, and December 31, 2020. Data were analyzed between November 2021 and August 2024.

Exposure: Time-varying use of systemic medications categorized as (1) methotrexate; (2) other older systemic medications; (3) anti-tumor necrosis factor (anti-TNF) biologics; (4) other biologics (targeting interleukin [IL]-12, IL-23, and IL-17); and (5) tofacitinib.

Main outcomes and measures: The main outcome was time to serious infection, defined as hospitalization for any infectious cause occurring up to March 2021. Multivariable Andersen-Gill recurrent event regression was used to estimate the association between each medication category and serious infection rates. The relative rates (RRs) of serious infection with 95% CIs for time actively using each medication category vs time not using that medication category were calculated.

Results: Of 11 641 new users of systemic therapy, 6114 (53%) were female, and the median (IQR) age was 71 (68-76) years. There were 1967 serious infections during a median (IQR) of 4.8 (2.3-8.4) years of follow-up. There were 2.7 serious infections per 100 person-years using methotrexate, 2.5 per 100 person-years using other older systemic drugs, 2.2 per 100 person-years using anti-TNF biologics, 1.4 per 100 person-years using other biologics, and 8.9 per 100 person-years using tofacitinib. In the multivariable-adjusted model, methotrexate (RR, 0.95 [95% CI, 0.85-1.07]), other older systemic medications (RR, 0.92 [95% CI, 0.79-1.07]), and anti-TNF biologics (RR, 0.87 [95% CI, 0.69-1.10]) were not associated with serious infection compared to person-time not using those respective medications. Other biologics (RR, 0.65 [95% CI, 0.48-0.88]) were associated with lower rates of serious infection, whereas tofacitinib (RR, 2.89 [95% CI, 1.14-7.34]) was associated with higher rates of serious infection.

Conclusions and relevance: In this cohort study, biologics targeting IL-12, IL-23, or IL-17 were associated with a lower rate of serious infection among older adults with psoriatic disease. These biologics may have important safety benefits for older adults with higher infection risk.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Drucker reported grants from the Canadian Institutes of Health Research (CIHR) during the study; compensation from the British Journal of Dermatology (reviewer, editor), American Academy of Dermatology (guidelines writer), Canadian Dermatology Today (manuscript writer), National Eczema Association, and Canada’s Drug Agency (consultant); and institutional research grants from the National Eczema Association, Eczema Society of Canada, Canadian Dermatology Foundation, CIHR, National Institutes of Health, and Physicians Services Incorporated Foundation. Dr Eder reported grants from AbbVie, Pfizer, Janssen, UCB, Novartis, and Lilly outside the submitted work. Dr Fralick reported personal fees from ProofDx; advisory roles for Signal1 outside the submitted work; holding a provisional patent for a dialysis prediction model; and serving as an expert witness on unrelated content. Ms MacDougall received an honorarium for participating in the study as a patient partner. No other disclosures were reported

Comment on

References

    1. Eder L, Widdifield J, Rosen CF, et al. . Trends in the prevalence and incidence of psoriasis and psoriatic arthritis in Ontario, Canada: a population-based study. Arthritis Care Res (Hoboken). 2019;71(8):1084-1091. doi:10.1002/acr.23743 - DOI - PubMed
    1. Bridgman AC, Fitzmaurice C, Dellavalle RP, et al. . Canadian burden of skin disease from 1990 to 2017: results from the Global Burden of Disease 2017 study. J Cutan Med Surg. 2020;24(2):161-173. doi:10.1177/1203475420902047 - DOI - PMC - PubMed
    1. Singh JA, Guyatt G, Ogdie A, et al. . Special article: 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Rheumatol. 2019;71(1):5-32. doi:10.1002/art.40726 - DOI - PMC - PubMed
    1. Menter A, Gelfand JM, Connor C, et al. . Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol. 2020;82(6):1445-1486. doi:10.1016/j.jaad.2020.02.044 - DOI - PubMed
    1. Menter A, Strober BE, Kaplan DH, et al. . Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80(4):1029-1072. doi:10.1016/j.jaad.2018.11.057 - DOI - PubMed