by Justin Jackson , Medical Xpress

Credit: Estzer Miller on Pixabay

Department of Medicine, University of Toronto, Women’s College Hospital, and co-authors have found biologics targeting interleukin (IL)-12, IL-23, or IL-17 were associated with a lower rate of serious infections among older adults with psoriatic disease. These biologics may have important safety benefits for older adults with higher infection risk compared to other existing treatments.

Psoriasis and psoriatic arthritis occur throughout adulthood, with previous research estimating the prevalence peaking at nearly 4% of individuals over 65 years. Older adults also face higher rates of serious infections and comorbidities. Concern over immunosuppression linked to systemic medications has prompted evaluation of different treatment options for psoriatic disease in this vulnerable population.

In the study, “Systemic Therapies for Psoriatic Disease and Serious Infections in Older Adults,” published in JAMA Dermatology, researchers used a cohort study to examine how medication choices might influence serious infection rates in this demographic.

Ontario residents 66 years and older with psoriatic disease were identified, and 11,641 individuals who received their first systemic therapy between April, 2002, and January, 2021, were included.

Population-based health data were used to analyze medication exposure and subsequent hospitalizations for infections. Andersen-Gill recurrent event regression models were applied to time-varying use of five medication categories, including older systemic drugs, methotrexate, various biologics, and tofacitinib.

Biologic therapies for psoriatic disease function through distinct mechanisms, with varying effects on infection risk. Researchers separated biologics targeting IL-12, IL-23, and IL-17 from anti-TNF biologics, including adalimumab, etanercept, and infliximab.

Findings showed that IL-targeting biologics were associated with a 35% lower rate of serious infections (RR: 0.65, 95% CI: 0.48–0.88), while anti-TNF biologics showed no significant difference in infection risk (RR: 0.87, 95% CI: 0.69–1.10). This distinction underscores a potential safety advantage of IL-12, IL-23, and IL-17 inhibitors for older adults managing psoriatic disease.

The researchers found 1.4 serious infections per 100 person-years during periods when newer biologics were used. Anti-TNF biologics, methotrexate, and other older systemic medications showed rates between 2.2 and 2.7 per 100 person-years.

Tofacitinib, a Janus kinase (JAK) inhibitor, demonstrated the highest serious infection risk in the study cohort. Users experienced 8.9 infections per 100 person-years, with a nearly threefold increased risk compared to non-users (RR: 2.89, 95% CI: 1.14–7.34). The FDA has issued boxed warnings for JAK inhibitors due to infection risks, aligning with these findings.

Researchers conclude that biologics targeting interleukin pathways may be safer alternatives for older adults with psoriatic disease who have higher infection risk. They note that these findings could inform clinical decisions and formulary policies regarding systemic treatment choices for older adults with psoriatic disease.

More information: Aaron M. Drucker et al, Systemic Therapies for Psoriatic Disease and Serious Infections in Older Adults, JAMA Dermatology (2025). DOI: 10.1001/jamadermatol.2025.0144

Andrea D. Maderal, Need for Consideration of Patient-Specific Risk Factors in Step Therapy, JAMA Dermatology (2025). DOI: 10.1001/jamadermatol.2025.0141

Journal information:JAMA Dermatology

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