Risk of infections in patients with psoriasis treated with biologic agents and new oral small molecules: BIOBADADERM registry.

Infections are the most common adverse events associated with systemic treatment for psoriasis. Using data from the BIOBADADERM registry, we analyzed incidence rates of overall, serious, and special-interest infections associated with biologics and oral small molecules. Adjusted incidence rate ratios were calculated using propensity score analysis, with adalimumab as the comparator. The study included 4820 patients (8826 treatment cycles; 20,829 patient years of follow-up). The overall incidence of serious infections was low across all treatments (5.33%), with infliximab showing the highest incidence rate. The most frequent serious infections were pneumonia, followed by COVID-19 pneumonia and cellulitis. Among nonserious infections, respiratory tract infections were most common, followed by COVID-19 and urinary tract infections. Risankizumab and ustekinumab were associated with significantly lower risk of overall infections than adalimumab (P < .002). The risk of Candida infections was significantly higher with bimekizumab, brodalumab, secukinumab, and ixekizumab. Guselkumab, secukinumab, ixekizumab, and ustekinumab were linked to reduced incidence of respiratory infections. Ixekizumab was associated with a lower risk of COVID-19 infection, whereas dimethyl fumarate showed an increased risk compared with adalimumab. Overall, our findings support the favorable safety profile of biologics and small molecules in psoriasis, particularly regarding serious infections.