TOPLINE:

Risankizumab demonstrated a lower risk for serious infections than brodalumab, etanercept, and standard treatments in patients with psoriasis over an extended follow-up period, according to a cohort study.

METHODOLOGY:

• Researchers conducted a cohort study analysing data of 46,770 treatment episodes from 18,976 adults with dermatologist-confirmed moderate-to-severe psoriasis recorded in the British Association of Dermatologists Biologic and Immunomodulators Register in the UK and Ireland from inception to November 2025 who had at least 6 months of follow-up.
• Systemic treatments included standard and targeted therapies; targeted therapies comprised TNF-alpha inhibitors, an interleukin (IL)-12/23 inhibitor, IL-17 inhibitors, IL-23 inhibitors, and a phosphodiesterase 4 inhibitor.
• The primary outcome was serious infection, defined as infection occurring during or within 90 days of treatment requiring hospitalisation or intravenous antimicrobials or resulting in death; secondary outcomes included treatment decisions after serious infection events, types of serious infection, and 30-day mortality.
• The inverse probability of treatment weighting method was used to balance baseline covariates across treatment groups. A recurrent event analysis using the Prentice-Williams-Peterson gap time model was performed to account for multiple serious infection episodes per patient.

TAKEAWAY:

• The rate of recurrent serious infection in patients who had one prior infection was 78.70 (95% CI, 75.17-82.36) events per 1000 person-years, which was approximately threefold higher than the overall incidence rate of first serious infection at 27.67 (95% CI, 26.72-28.65) events per 1000 person-years.
• An increased risk for serious infection was observed with apremilast (hazard ratio [HR], 1.53; 95% CI, 1.27-1.80) and secukinumab (HR, 1.34; 95% CI, 1.18-1.50) compared to that with adalimumab, but these findings were not simultaneously observed across sensitivity analyses.
• In the recurrent event analysis, risankizumab was associated with a lower risk for serious infection than brodalumab (HR, 0.74; 95% CI, 0.55-0.99), etanercept (HR, 0.75; 95% CI, 0.60-0.94), and standard treatments (HR, 0.80; 95% CI, 0.65-0.98).
• After a serious infection event, 67.8% of patients continued the treatment, 18.2% discontinued the treatment, 10.0% switched the treatment, and 4.0% postponed the treatment.
• The most frequent type of reported serious infection was in the respiratory tract (26.1%), followed by the urinary tract (10.5%), gastrointestinal tract (10.5%), blood (9.1%), and skin (5.3%). Serious infection-associated deaths were rare, with an incidence rate of 1.81 (95% CI, 1.57-2.07) per 1000 person-years within 30 days.

IN PRACTICE:

"[The study] findings together support treatment decisions based on patient characteristics, with risankizumab offering a potential option for those concerned about serious infection risk, while reinforcing that treatment-associated serious infection risk should not be a sole determinant in therapy selection," the authors wrote.

SOURCE:

This study was led by Heber Rew Bright Bright, Dermatology Centre, Northern Care Alliance NHS Foundation Trust and Division of Musculoskeletal and Dermatological Sciences, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, England. It was published online on May 05, 2026, in the British Journal of Dermatology.

LIMITATIONS:

As with all cohort studies, unmeasured residual confounding may have influenced the findings. With approximately 30% of data missing, there was a risk for inaccurate treatment comparisons — especially for weight-dependent dosing — and a potential underestimation of true protective effects. The absence of vaccination status and the presence of potential treatment selection bias (in which patient characteristics may have influenced drug choice) further complicated the results. Additionally, the two-decade study span introduced variables such as evolving clinical practices and new healthcare access patterns. Finally, small sample sizes for specific medications, such as bimekizumab, may have compromised the reliability of certain statistical estimates.

DISCLOSURES:

This study was supported by the British Association of Dermatologists Biologic Register Ltd, the Psoriasis Association, and the National Institute for Health and Care Research Manchester Biomedical Research Centre. One author reported receiving research grants and/or acting as a consultant for AbbVie, Almirall, and various other sources. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.