Report: Antibiotics Linked to Shorter Biologic Persistence in Psoriasis
Key Takeaways
Systemic antibiotic use were associated with reduced biologic therapy persistence in patients with psoriasis in a new report in JAMA Dermatology.
The researchers reported a dose-response relationship and multiple antibiotic courses correlating with higher discontinuation risk.
- The most prescribed antibiotic classes were β-lactams, macrolides, and fluoroquinolones.
Antibiotic exposure is associated with reduced persistence of biologic therapies in patients with psoriasis, according to findings from a nationwide French cohort study published in JAMA Dermatology.
Using data from 36,129 adults in the French National Health Insurance database, researchers observed a dose-dependent relationship between systemic antibiotic use and risk of biologic discontinuation over a 10-year period. Study participants included adults on first biologic treatment for psoriasis between 2012 and 2022, with follow-up through 2024. Exposure to antibiotics was measured at baseline (6 months prior to biologic) and longitudinally during therapy. Persistence was defined as time to discontinuation or switch of the index biologic.
According to the data, almost 26% of patients received antibiotics before starting biologic therapy; 61% were exposed during follow-up. Multivariable analyses revealed that antibiotic exposure in the preceding 6 months was linked to a 12% higher risk of discontinuation (HR = 1.12; 95% CI, 1.08 to 1.16), increasing to 29% with two or more dispensations (HR = 1.29; 95% CI, 1.24 to 1.35).
The most prescribed antibiotic classes were β-lactams, macrolides, and fluoroquinolones. Subgroup analyses by biologic class confirmed the findings. The authors suggested that gut microbiota may play a role in the impairment of the immune-modulating mechanisms of biologics, possibly contributing to treatment failure.
“These findings support the hypothesis that antibiotics, potentially through gut dysbiosis, may reduce biologic persistence,” the authors wrote. “However, unmeasured confounders limit causal interpretation. Further studies are necessary to validate these findings.”
Source: Ouakrat R, et al. JAMA Dermatology. 2025. Doi:10.1001/jamadermatol.2025.4427