A RECENT cohort study has provided valuable insights into the association between systemic medications for psoriatic disease and serious infections among older adults. Conducted in Ontario, Canada, the study examined 11,641 adults aged 66 and older who were prescribed systemic treatments for psoriasis or psoriatic arthritis between 2002–2021. The findings suggest that biologics targeting interleukin (IL)-12, IL-23, and IL-17 may offer a safer alternative for older patients, as their use was linked to a 35% lower rate of serious infection compared to periods when patients were not using these medications.
The study assessed the risk of hospitalisation for serious infections based on different categories of systemic medications, including methotrexate, other older systemic drugs, tumour necrosis factor (TNF) inhibitors, newer biologics targeting IL-12, IL-23, and IL-17, and tofacitinib. Researchers used multivariable-adjusted models to estimate infection risk relative to non-use of each medication. The results indicated no significant change in infection risk for methotrexate (relative rate [RR] 0.95), older systemic drugs (RR 0.92), or TNF inhibitors (RR 0.87). However, biologics targeting IL-12, IL-23, and IL-17 demonstrated a protective effect, with a significantly lower rate of serious infections (RR 0.65). In contrast, tofacitinib was associated with an increased infection risk (RR 2.89), raising concerns about its safety for older adults.
During the study period, 1,967 serious infections were recorded over a median follow-up of 4.8 years. Infection rates varied across medication types, with methotrexate users experiencing 2.7 infections per 100 person-years, those on older systemic drugs at 2.5, TNF inhibitors at 2.2, newer biologics at 1.4, and tofacitinib users at 8.9. The significantly lower infection rate associated with IL-12, IL-23, and IL-17 biologics suggests they may be a preferred option for older adults, who are inherently at greater risk of infection.
These findings highlight the importance of selecting appropriate treatments for older patients with psoriatic disease. The study supports the use of newer biologics as a potentially safer alternative while raising caution regarding tofacitinib, which may pose a heightened infection risk in this vulnerable population.
Reference
Drucker AM et al. Systemic therapies for psoriatic disease and serious infections in older adults. JAMA Dermatol. 2025;DOI:10.1001/jamadermatol.2025.0144.
