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Serious infections and tuberculosis in psoriasis patients receiving systemic therapy in Korea: a nationwide population-based cohort study

  • Therapy
  • Published:
European Journal of Dermatology

Abstract

Background

Psoriasis itself, as well as its immunomodulatory drugs, may alter the immune system, increasing the risk of infections. Recent research has indicated that patients with psoriasis are at an increased risk of developing severe infections including tuberculosis.

Objectives

To evaluate and compare the incidence of serious infectious diseases in Korea between patients with psoriasis and participants without psoriasis regarding each treatment modality.

Materials & Methods

This nationwide cohort study utilized claims data based on the National Health Insurance Service between January 2005 and December 2018.

Results

In total, 293,073 patients with psoriasis enrolled for the analysis of serious infection and 272,400 patients enrolled for the analysis of tuberculosis. Participants without psoriasis matched by age and sex (1:1 ratio) were also enrolled. For serious infection overall, the adjusted hazard ratios (aHRs) (95% confidence interval [CI]) were 1.21 (1.20–1.23), 1.23 (1.17–1.28), and 1.33 (1.09–1.63) for the non-systemic, non-biologic systemic, and biologic groups, respectively. For tuberculosis overall, the aHRs were 1.15 (1.10–1.20), 1.32 (1.10–1.57), and 6.72 (4.28–10.56) for the non-systemic, non-biologic systemic, and biologic groups, respectively.

Conclusion

This study reveals that the risk of serious infection and tuberculosis in patients with psoriasis was significantly higher than in participants without psoriasis. Moreover, patients with psoriasis who received systemic therapy other than phototherapy had a higher risk of these infections compared to those without psoriasis. Also, biologics appeared to increase the risk of tuberculosis in patients with psoriasis. Dermatologists should consider these potential risks when selecting treatment modalities for psoriasis.

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Data availability: data from the Korean National Health Insurance-National Health Information Database (NHIS-NHID) cannot be provided without request.

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Funding

Funding sources: this work was supported by the Konkuk University Medical Center Research Grant 2022. The funding source did not have any involvement in the study.

Author information

Author notes

  1. These authors contributed equally

Authors and Affiliations

  1. Department of Dermatology, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea

    Young Ah Cho, Ji Youn Hong, Sung Min Kim, Jae Young Sung, Chang Yong Kim, Da-Ae Yu, Yang Won Lee & Yong Beom Choe

  2. Department of Public Health Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea

    Juhee Ahn & Sungho Won

  3. Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea

    Sungho Won

  4. RexSoft Inc, 542 Yeoksam-ro, Gangnam-gu, Seoul, 06187, Republic of Korea

    Sungho Won

  5. Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea

    Da-Ae Yu, Yang Won Lee & Yong Beom Choe

Authors
  1. Young Ah Cho
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  2. Juhee Ahn
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  9. Yang Won Lee
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Corresponding author

Correspondence to Yong Beom Choe.

Ethics declarations

Conflicts of interest: Yong Beom Choe has received research grants from the Konkuk University Medical Center. The remaining authors have no conflicts of interest to declare.

Ethics approval: this study was permitted by the by the Institutional Review Board in Konkuk University Medical Center.

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Cite this article

Cho, Y.A., Ahn, J., Hong, J.Y. et al. Serious infections and tuberculosis in psoriasis patients receiving systemic therapy in Korea: a nationwide population-based cohort study. Eur J Dermatol 33, 287–295 (2023). https://doi.org/10.1684/ejd.2023.4500

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  • DOI: https://doi.org/10.1684/ejd.2023.4500

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