Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

No Infection Increase Seen With Biologics in Older Psoriasis Patients

Key clinical point: The risk of serious infection in older psoriasis patients doesn’t differ regardless of whether they’re on a biologic, a nonbiologic systemic, or phototherapy.

Major finding: The risk of serious bacterial or opportunistic infection is 2.24-fold greater in older psoriasis patients not on systemic therapy than in age-matched nonpsoriatic controls.

Study details: This was a propensity score–matched study of the risk of serious infections during the first 6 months after 8,119 psoriasis patients age 65 years or older newly initiated treatment with a biologic, a nonbiologic systemic drug, or phototherapy.

Disclosures: The study was entirely funded by Brigham and Women’s Hospital. The presenter reported serving as a consultant to and/or recipient of research grants from nearly two dozen pharmaceutical companies.


Merola JF. EADV 2019.


This single center study demonstrates that the risk of serious infections associated with biologic agents is not increased in older patients, compared with other types of therapy. Even though psoriasis patients aged 65 years and older are at more than twice the risk of serious bacterial and opportunistic infection compared with younger psoriasis patients, risk is not further elevated with biologic agents. One limitation of this study is that all classes of biologic agents were grouped together and not separated by mechanism of action. Nonetheless, based on this study, providers should not be hesitant to recommend biologic agents to elderly patients due to concern for serious infection risk.—Paul S. Yamauchi, MD, PhD; Clinical Assistant Professor of Dermatology David Geffen School of Medicine at UCLA; Harbor-UCLA Medical Center Division of Dermatology; Adjunct Associate Professor John Wayne Cancer Institute.