Low Infection Risk Across Psoriasis Biologics Reported in Real-World Study

Key Takeaways

• A new French cohort study of biologic-naïve patients with psoriasis found overall infection rates were low across biologic therapies.
• Ustekinumab and IL-23 inhibitors were associated with the lowest overall infection risk compared with adalimumab.
• IL-17 inhibitors demonstrated comparable serious infection risk but were associated with increased antifungal use.

A large real-world analysis published in the Journal of the American Academy of Dermatology indicates biologic therapies for psoriasis are associated with low overall infection risk, with ustekinumab and interleukin (IL)-23 inhibitors showing the most favorable safety profiles.

Nationwide Analysis Compares Infection Risk Across Psoriasis Biologics

Investigators looked at data from the French National Health Data System between 2013 and 2022, identifying 39,669 adults with psoriasis who were new users of biologic therapy. The study evaluated both serious infections requiring hospitalization and outpatient-treated infections, offering one of the most comprehensive assessments of infectious risk across biologic classes to date.

During follow-up, inpatient-managed infections occurred at a rate of 27.1 per 1,000 person-years. Overall exposure to anti-infective medications remained low, with a median systemic anti-infective coverage of 5.5% during biologic treatment.

Using adalimumab as the reference comparator, investigators saw lower risks of hospitalization for infection among patients receiving ustekinumab (weighted hazard ratio [wHR], 0.75), secukinumab (wHR, 0.72), and risankizumab (wHR, 0.57).

Antibacterial use was lower among patients receiving ustekinumab, guselkumab, and risankizumab in the outpatient setting, while certolizumab was associated with increased antibacterial use. IL-17 inhibitors (secukinumab, brodalumab, and ixekizumab) were linked to higher antimycotic use. Study limitations included reliance on administrative claims data, lack of clinical disease severity measures, and the inability to capture infections not treated with anti-infective medications.

“Biologics were associated with low infection risks among patients with psoriasis,” the authors concluded. “Among biologics, ustekinumab and IL-23i showed the lowest overall risk (time to the first inpatient/outpatient event).”

Source

Le TTK, et al. JAAD. 2026. Doi:10.1016/j.jaad.2026.01.024