12 Dicembre 2022
Wang YC, Lin YH, Ma SH, et al.

Infection risk in psoriatic patients receiving tumour necrosis factor inhibitors: a 20-year systematic review and meta-analysis of randomized controlled trials

J Eur Acad Dermatol Venereol. 2022 Dec;36(12):2301-2315
  • Obiettivo della presente metanalisi è stato valutare il rischio d’infezioni nei pazienti con psoriasi in trattamento con gli inibitori del tumor necrosis factor.
  • È emerso un rischio globale lievemente aumentato d’infezioni (RR = 1,09; IC 95%, 1,02-1,15), ma non d’infezioni gravi (RR = 0,95; IC 95%, 0,61-1,49); non è risultato un rischio aumentato d’infezioni delle alte vie aeree (RR = 1,10; IC 95%, 0,94-1,28) o di rinofaringiti (RR = 1,14; IC 95%, 1,00-1,30).
  • All’analisi per sottogruppi, solamente etanercept e certolizumab pegol sono risultati, rispettivamente, associati ad un rischio globale aumentato d’infezioni (RR = 1,14, IC 95%, 1,03-1,27) e di quelle delle alte vie aeree (RR = 1,42, IC 95%, 1,02-1,98).


Tumour necrosis factor inhibitors (TNFis) are commonly used for treating psoriatic diseases; however, the risk of infection while receiving TNFis remains uncertain. The aim of this study was to investigate the infection risk in patients with psoriatic disease receiving TNFis. A prospectively registered systematic literature search was conducted in Medline (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and the databases from inception to December 31, 2021. We included double-blind randomized controlled trials that compared TNFis or other biologics with placebo in adults with psoriasis or psoriatic arthritis. The primary outcomes included overall and serious infection risks, and secondary outcomes included upper respiratory infections and nasopharyngitis risks. The risk ratio of the dichotomous outcome was calculated using the Mantel-Haenszel method with random effects, and heterogeneity was assessed using Cochran’s Q statistic and quantified using the I-squared statistic. A total of 48 studies with 15 464 patients with psoriatic diseases were included. The meta-analysis demonstrated a slightly increased overall infection risk (risk ratio = 1.09; 95% confidence interval, 1.02-1.15) but not serious infection risk (risk ratio = 0.95; 95% confidence interval, 0.61-1.49) among patients receiving TNFis. There were also no increased risks of upper respiratory infections (risk ratio = 1.10; 95% confidence interval, 0.94-1.28) or nasopharyngitis (risk ratio = 1.14; 95% confidence interval, 1.00-1.30). In subgroup analyses using the fixed effects model, only etanercept and certolizumab pegol were, respectively, associated with an increased risk of overall infection (RR = 1.14, 95% CI, 1.03-1.27) and upper respiratory infections (RR = 1.42, 95% CI, 1.02-1.98). In conclusion, evidence to date suggests an increased overall infection risk that is generally tolerable in patients with psoriatic diseases receiving TNFis. There are no increased risks of serious infections, upper respiratory infections or nasopharyngitis.

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