Risk of common infections among individuals with psoriasis in Sweden: A nationwide cohort study comparing secukinumab to ustekinumab

• Published in: Pharmacoepidemiology and drug safety 2020-12, Vol.29 (12), p.1562-1569
• Main Authors: Srinivas, Chaitra, Odsbu, Ingvild, Linder, Marie
• Format: Article
• Language: English
• Subjects: Antibiotics; Arthritis; biologic drugs; Candidiasis; Cohort analysis; cohort study; Immunotherapy; infections; Medicin och hälsovetenskap; Monoclonal antibodies; Original Report; Original Reports; pharmacoepidemiology; population register; Primary care; Psoriasis; Respiratory tract diseases; Urinary tract; Urinary tract diseases; Urinary tract infections; Urogenital system
• ISSN: 1053-8569; 1099-1557; 1099-1557
• DOI: 10.1002/pds.5132

Purpose To determine risk of respiratory tract infections, urinary tract infections and candidiasis in secukinumab users compared to ustekinumab users among individuals with psoriasis in Sweden. Methods This was a Swedish population‐based register‐linked new‐user cohort study on individuals with psoriasis and psoriasis arthritis treated with secukinumab (2015‐2017) and ustekinumab (2009‐2017). Ever‐never exposure definition was used, that is, each individual's follow‐up time was attributed to the drug they were first exposed to. Risk of severe respiratory and urinary tract infections and candidiasis (diagnosis codes from out‐patient specialist visits and in‐patient hospitalisations) and respiratory and urinary tract infections treated in primary care (proxied by dispensation of antibiotics) was determined by adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox regression. We also give crude incidence rates and rate ratios. Results In total, 1955 new users of secukinumab (n = 848) and ustekinumab (n = 1107) were identified. There was a slightly increased risk of respiratory and urinary tract infections treated in primary care among secukinumab users compared to ustekinumab users (HR: 1.22, 95% CI: 1.03‐1.43). Non‐significant differences in estimated risk of severe respiratory and urinary tract infections (HR: 0.96, 95% CI: 0.57‐1.61) and candidiasis (HR: 1.80, 95% CI: 0.84‐3.84) treated in the hospital setting were observed. Conclusion We observed a slightly increased risk of respiratory and urinary tract infections treated in primary care among secukinumab users compared to ustekinumab users. Larger studies with longer follow‐up are needed to draw conclusions on relative safety.