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Abstract Number: 2566

Comparisons of the Risk of Serious Infections Associated with the Different Classes of Targeted Therapies Used in Psoriatic Arthritis Patients: A Nationwide Cohort Study from the French Health Insurance Database

Léa Bastard1, pascal claudepierre2, Laetitia Penso3, Emilie Sbidian4 and Laura PINA VEGAS5, 1Henri Mondor University Hospital (APHP) / Rheumatology Department, Créteil, France, 2Universitary Henri Mondor Hospital, Creteil, France, 3Université Paris Est Créteil, Créteil, France, 4Hôpital Henri Mondor, Université Paris Est Créteil, Créteil, France, 5Henri Mondor University Hospital (APHP), Rheumatology Department, Créteil, France

Meeting: ACR Convergence 2023

Keywords: Data Management, Epidemiology, Infection, Psoriatic arthritis

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Session Information

Date: Wednesday, November 15, 2023

Title: Abstracts: Epidemiology & Public Health III

Session Type: Abstract Session

Session Time: 9:00AM-10:30AM

Background/Purpose: Targeted therapies have demonstrated their efficacy in the treatment of psoriatic arthritis (PsA), with an increased risk of serious infections. However, a comparison of this risk according to the different classes of drugs, in real world settings, remains an unmet need. This study aimed to assess and compare the risk of serious infections associated with different targeted therapies used in PsA from a national healthcare database.

Methods: This nationwide cohort study used data from the French National Health Insurance Database (SNDS), which covers over 98.8% of the French population.

All adults aged over 18 years with PsA registered in the SNDS were eligible for inclusion between January 1, 2015 and June 30, 2021. New users of targeted therapies (adalimumab, etanercept, golimumab, certolizumab, infliximab [TNFi], secukinumab and ixekizumab [IL17i], ustekinumab [IL12/23i], and tofacitinib [JAKi]) were included, defined as patients who had no previous prescriptions of targeted therapies in the year prior the index date. Patients with HIV infection, a history of cancer, transplant or serious infection were excluded. The follow-up period extended to December 31, 2021. The primary end point was the occurrence of a serious infection in a time-to-event analysis using propensity score-weighted Cox proportional hazards regression models, with adalimumab as comparator, estimating weighted hazard ratios (wHR) with their corresponding 95% confidence intervals (CIs). Other drugs used as add-on therapies (csDMARDs, NSAIDs and prednisone) were considered as time-dependant covariables.

Results: Between 2015 and 2021, 12,071 new users of targeted therapies were included (mean age 48.7 ± 12.7 years; 6,909 [57.8%] women; median follow-up 13.2 [interquartile range: 6.4-31.5] months).

Among new users, 8,946 (74.1%) were treated with a TNFi, 1,796 (14.9%) with an IL17i, 1,177 (9.8%) with an IL12/23i, and 152 (1.3%) with a JAKi.

The total number of serious infections was 367, with an overall crude incidence rate of 17.0 (95%CI, 15.2-18.7) per 1,000 person-years. The most frequent serious infections were pulmonary infections (94 [0.8%] patients) (Table 1).

After inverse propensity weighting and adjustment for time-dependent covariables, risk of serious infection appeared significantly lower for patients receiving etanercept (wHR, 0.70; 95%CI, 0.54-0.93) or ustekinumab (wHR, 0.56; 95%CI, 0.36-0.89) than for those receiving adalimumab. No significant difference in the risk of serious infection was detected for the other targeted therapies (Figure 1). Concomitant use of systemic corticosteroids was associated with an increased risk of serious infection (wHR, 1.85; 95%CI, 1.48-2.31).

Conclusion: Overall, the incidence of serious infections associated with targeted therapies used in PsA patients in real world settings is low. Compared with new users of adalimumab, this risk was lower among new users of etanercept and ustekinumab, with no difference among new users of the other TNFi, IL17i or JAKi. Given the numerous therapeutic options available for PsA treatment, these findings could assist physicians in optimizing their therapeutic strategies based on individual patients’ characteristics.

Supporting image 1

Table 1. Serious infections and deaths events according to the targeted therapy used among psoriatic arthritis (PsA) patients between 2015 and 2021 in France. No., number; Mo., months; IQR, interquartile range; ENT, ear nose throat; NA, not applicable.

Supporting image 2

Figure 1. Forest plot of the risk of serious infection in patients with psoriatic arthritis (PsA), new users of targeted therapy, analysed by a time-to-event analysis using propensity score-weighted Cox proportional hazards regression models, estimating weighted hazard ratios (wHR) with their corresponding 95% confidence intervals (CIs). Ref, reference; wHR, weighted hazard ratio; CI, confidence interval.


Disclosures: L. Bastard: None; p. claudepierre: AbbVie/Abbott, 2, Amgen, 2, Biogen, 6, Bristol-Myers Squibb(BMS), 2, 4, Celltrion, 6, Eli Lilly, 2, Galapagos, 2, Janssen, 2, Merck/MSD, 2, 4, Novartis, 2, 4, Pfizer, 2, 4, Roche, 2, 4, UCB, 2; L. Penso: None; E. Sbidian: None; L. PINA VEGAS: None.

To cite this abstract in AMA style:

Bastard L, claudepierre p, Penso L, Sbidian E, PINA VEGAS L. Comparisons of the Risk of Serious Infections Associated with the Different Classes of Targeted Therapies Used in Psoriatic Arthritis Patients: A Nationwide Cohort Study from the French Health Insurance Database [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/comparisons-of-the-risk-of-serious-infections-associated-with-the-different-classes-of-targeted-therapies-used-in-psoriatic-arthritis-patients-a-nationwide-cohort-study-from-the-french-health-insuran/. Accessed .
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