Infection Risks Differ in Two Patient Groups on Adalimumab

TOPLINE:

Among adults treated with adalimumab, those with hidradenitis suppurativa (HS) showed a 53% higher risk for serious infections than adults with psoriasis, with notably increased risks for sepsis and genitourinary infections.

METHODOLOGY:

• Researchers conducted a retrospective cohort study of 10,349 adults (mean age, 44.8 years; 54.5% women) with HS (n = 1650) or psoriasis (n = 8699) from the MarketScan database who initiated treatment with adalimumab between January 2017 and December 2020.
• Patients with HS were younger (mean age, 36.2 vs 46.5 years), mostly women (77% vs 50.2%), and had higher rates of obesity, Crohn’s disease, anxiety, and depression than those with psoriasis.
• The primary outcome was hospitalization for noncutaneous infections. Secondary outcomes included infection types and length of hospital stay.
• The median follow-up was 1.01 years in the HS group and 1.29 years in the psoriasis group (P < .001).

TAKEAWAY:

• In the HS group, 73 hospitalizations were recorded compared with 300 in the psoriasis group. The overall unadjusted incidence of infections was higher in the HS group (incidence rate ratio [IRR], 1.56; 95% CI, 1.38-1.79).
• Patients with HS showed a significantly higher risk for serious infection with adalimumab than those with psoriasis (hazard ratio, 1.53; 95% CI, 1.34-1.86).
• Patients with HS showed a higher likelihood of sepsis (IRR, 2.07; 95% CI, 1.35-3.12) and genitourinary tract infections (IRR, 2.22; 95% CI, 1.22-3.86).
• Patients with HS also had higher odds of a longer hospital stay (odds ratio, 1.28; 95% CI, 1.13-1.45).

IN PRACTICE:

The study findings “underscore the need for strategies to reduce the infection risk” in patients with HS, the authors of the study wrote. More studies, they added, “will be important to further understand the risk of infection in this population, focusing on the contribution of the disease severity and therapeutic regimens, as well as investigating prophylactic strategies to reduce infection burden in the HS population.”

SOURCE:

The study was led by Bruna Galvao de Oliveira Wafae, MD, MMSc, Department of Dermatology, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Boston, and was published online on August 20 in JAMA Dermatology.

LIMITATIONS:

The study did not account for steroid and antibiotic use or dose-dependent effects of adalimumab. Diagnosis algorithms for HS had limited validation.

DISCLOSURES:

The authors did not report any funding information. Wafae disclosed serving as an investigator for AbbVie, Eli Lilly and Company, Incyte, Moonlake, Avalo, Prometheus, Sanofi, Insmed, UCB, and Bristol Myers Squibb. Other authors reported receiving nonfinancial support, personal fees, investigator fees, and grants from the HS Foundation, Incyte, UCB, Dermatology Foundation, Boehringer Ingelheim, argenx, Takeda, and various other companies outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.