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What Is the Long-term Safety of Systemic Psoriasis Medications?

Ustekinumab (Stelara), an IL-12/23 inhibitor, and secukinumab (Cosentyx), an IL-17 inhibitor, appeared to be the safest systemic therapies in a study of real-world patients with psoriasis.

Using data from the Biobadaderm Registry, the researchers analyzed the safety of acitretin, adalimumab (Humira), apremilast (Otezla), cyclosporine, etanercept (Enbrel), infliximab (Remicade), methotrexate, secukinumab, and ustekinumab among 2845 patients with moderate to severe psoriasis over a period of 9642 patient-years equal to 8954 treatment cycles. They calculated the incidence rate ratio (IRR) and adjusted IRR of adverse events for each systemic therapy, using methotrexate as a reference.
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The researchers found that ustekinumab and secukinumab had the lowest rate of adverse events for several of the system organ classes, with a statistically significant decreased rate ratio and IRR of less than 1. Conversely, cyclosporine and infliximab had the highest rate of adverse events, with an increased rate ratio and IRR greater than or equal to 5.

“Our data provide comparative safety information in the real-life setting that could help clinicians selecting between available products,” the researchers concluded.


Daudén E, Carretero G, Rivera R, et al. Long term safety of nine systemic medications for psoriasis: a cohort study using the Biobadaderm Registry [published online March 22, 2020]. J Am Acad Dermatol. doi:10.1016/j.jaad.2020.03.033

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