Department of Dermatology, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea.
Department of Public Health Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
Eur J Dermatol. 2023 Jun 1;33(3):287-295. doi: 10.1684/ejd.2023.4500.
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.
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.
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.
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.
银屑病本身及其免疫调节剂可能会改变免疫系统，增加感染的风险。最近的研究表明，银屑病患者发生包括结核病在内的严重感染的风险增加。
评估和比较银屑病患者在不同治疗方式下，与无银屑病参与者相比，发生严重感染性疾病的风险。
本项全国性队列研究利用了 2005 年 1 月至 2018 年 12 月间国家健康保险服务的索赔数据。
共纳入 293073 例银屑病患者进行严重感染分析，纳入 272400 例患者进行结核病分析。按照年龄和性别（1:1 比例）匹配无银屑病的参与者也被纳入研究。总体而言，对于严重感染，非系统性、非生物性系统性和生物制剂组的校正危害比（aHR）（95%置信区间[CI]）分别为 1.21（1.20-1.23）、1.23（1.17-1.28）和 1.33（1.09-1.63）。对于结核病，非系统性、非生物性系统性和生物制剂组的 aHR 分别为 1.15（1.10-1.20）、1.32（1.10-1.57）和 6.72（4.28-10.56）。
本研究显示，银屑病患者发生严重感染和结核病的风险显著高于无银屑病参与者。此外，与无银屑病参与者相比，接受除光疗以外的系统性治疗的银屑病患者发生这些感染的风险更高。此外，生物制剂似乎会增加银屑病患者发生结核病的风险。皮肤科医生在选择银屑病的治疗方案时应考虑这些潜在风险。
