Episode 47 - Serious infection risk with systemic treatments for psoriasis

In this episode of BJD Talks, Sam and Meera discuss the article ‘Serious infection risk with systemic treatments for psoriasis: a cohort study from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR)’ by Bright et al. The full article can be accessed at https://doi.org/10.1093/bjd/ljag174

 *This podcast was generated by an AI tool created by 67Bricks for the British Association of Dermatologists*

Transcript

SPEAKER_00 0:00

Welcome to BJD Talks, the official podcast of the BJD. I'm Sam.

SPEAKER_01 0:04

And I'm Mira. In this episode, we will be discussing the article by Bright et al. Serious Infection Risk with Systemic Treatments for Psoriasis. A cohort study from the British Association of Dermatologists, Biologics and Immunomodulators Register, published in May 2026 and included in the August 2026 issue.

SPEAKER_00 0:27

This cohort study, using data from the British Association of Dermatologists, Biologics and Immunomodulators Register, or BADBEAR, focuses on the risk of serious infections linked to systemic psoriasis treatments, a topic that is vital for those managing the condition.

SPEAKER_01 0:42

Yes, and the study is substantial, including nearly 19,000 patients with moderate to severe psoriasis, tracked for an average of over four years. The dataset size really strengthens the findings, doesn't it?

SPEAKER_00 0:55

Indeed. Considering bad beer is one of the largest psoriasis registries worldwide, it gives this research significant weight. The focus was on how older treatments such as methotrexate and more modern biologics like IL-17 and IL-23 inhibitors impact infection risk.

SPEAKER_01 1:14

The study looked at serious infections leading to hospitalization, intravenous antimicrobials, or death, comparing 12 treatments such as TNF alpha inhibitors like adulemumab and newer IL-23 inhibitors like riceancasumab.

SPEAKER_00 1:30

They use two analytical approaches: a time-to-first infection model and a recurrent event analysis. Both models contribute important perspectives. What did you find compelling, Mira?

SPEAKER_01 1:41

A premylast and securineumab initially suggested an increased risk of serious infections compared to adolymumab, but this wasn't consistent in sensitivity analyses, hinting at potential confounding factors, limited sample sizes, or random chance.

SPEAKER_00 1:57

And in the recurrent event analysis, which tracked every reported serious infection, rhizanquizumab was associated with a significantly lower risk compared to treatments like etanocept, brotoilumab, and methotrexate.

SPEAKER_01 2:10

Although the absolute difference was modest, around 11 to 13 fewer infections with rhizancizumab per 1,000 person years, it may still be clinically significant.

SPEAKER_00 2:21

On the whole, serious infection rates were low. 27.67 events per 1,000 person years for the first infection and 78.7 for recurrent infections. Incidences of infection-related deaths were just 1.81 per 1000 person years.

SPEAKER_01 2:38

Reassuring figures. Still, as the authors noted, about 30% of the data for key variables like BMI and per C scores was missing. They also couldn't account for vaccination status, an important consideration for infection risks.

SPEAKER_00 2:53

Additionally, shifts in clinical practices during the nearly 20-year study and small sample sizes for some treatments, such as bimicizumab, might have influenced comparisons.

SPEAKER_01 3:04

Even with these limitations, this study offers valuable real-world insights. While systemic treatments are generally safe, patient-specific factors must guide decisions. Risancasumab could be a preferred choice for those particularly concerned about infection risks.

SPEAKER_00 3:19

Also noteworthy is that two-thirds of patients continued their treatment following a serious infection, reflecting how treatment decisions play out in practice.

SPEAKER_01 3:28

To conclude, systemic treatments for psoriasis come with some degree of risk, but serious infections remain uncommon. Risan Kazumab demonstrates a lower risk for recurrent infections, but personalized care remains paramount.

SPEAKER_00 3:43

Precisely. Thanks to Badbeer's robust data, we have a clearer understanding of these risks, which aids better decision making for patients. That's it for today. Thank you for tuning into BJD Talks.

SPEAKER_01 3:54

And thank you, Sam. We'll see you all next time for more discussions on the latest dermatology research.