HS Patients on Adalimumab Face Higher Risk of Serious Infections than PsO Counterparts
Key Takeaways
Patients with hidradenitis suppurativa (HS) initiating adalimumab had an increased risk of hospitalization for noncutaneous infections vs patients with psoriasis.
Sepsis and genitourinary infections occurred at more than twice the rate in HS patients relative to psoriasis patients, according to the data.
HS patients had higher odds of prolonged hospitalization due to infection despite having similar average hospital stay durations.
Patients with hidradenitis suppurativa (HS) initiating adalimumab face a significantly higher risk of serious, noncutaneous infections requiring hospitalization compared with patients with psoriasis, a new cohort study finds.
Researchers evaluated 10,349 adult US patients starting adalimumab (1,650 with HS and 8,699 with psoriasis). Patients with HS were generally younger (mean age 36.2 vs 46.5 years) and more often female (77% vs 50%). The study excluded cutaneous infections to avoid misclassifying HS flares as infectious events, and it controlled for age, comorbidities, and disease severity proxies.
After inverse probability weighting, HS patients showed a 53% greater hazard of noncutaneous infection (NCI) hospitalization vs psoriasis patients (HR = 1.53; 95% CI, 1.34 to 1.86). Sepsis (IR = 16.02 per 1000 person-years) and genitourinary infections (IR = 9.01) were the most common serious infections in the HS cohort (both occurred at more than double the rates seen with psoriasis). While mean length of hospitalization was comparable between groups (~5 days), patients with HS had 28% higher odds of longer stays after adjustment (OR = 1.28; 95% CI, 1.13 to 1.45).
Multiple sensitivity analyses confirmed the findings, including stricter diagnostic coding and alternative statistical models. The authors emphasize the need for infection risk mitigation strategies in the HS population, particularly given the chronic nature of the disease and the prolonged immunomodulatory therapy often required.
"These findings underscore the need for strategies to reduce the infection risk in this population," the authors concluded. "Future studies 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: Wafe B, et al. JAMA Dermatology. 2025. doi:10.1001/jamadermatol.2025.2881