AT A GLANCE

A new study published in JAMA Dermatology found no significant difference between the incidence of serious bacterial and opportunistic infections requiring hospitalization in psoriatic arthritis (PsA) patients receiving combination targeted therapy versus standard therapy.¹

“Achieving good disease control in PsA remains a major challenge. Combining multiple systemic immunomodulatory therapies has been shown to be beneficial in other immune-mediated diseases with reasonable safety profiles, but data on the current use and safety of combination targeted therapy among individuals with PsA are limited,” explain study authors Wu et al., who sought to evaluate the use and safety of combination targeted therapies among adults with PsA using data from the IBM MarketScan Commercial Claims Database.

For study purposes, data collected from January 2015 to December 2024 were assessed to describe use patterns and perform safety analyses. A validated claims algorithm was used to identify adults with PsA, who were separated into a standard therapy control cohort matched 2:1 with the combination targeted therapy cohort. A descriptive analysis of the use of combination targeted therapies was performed, and a safety analysis was completed that involved a comparison of frequencies of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes for serious or opportunistic infections requiring an inpatient level of care. Relative risks (RRs) were calculated before and after propensity score matching.

According to the authors, 542 individuals of a total 82,399 identified PsA patients were found to be receiving combination targeted therapy for three consecutive months and 200 were found to be receiving combination therapy for six consecutive months. The 2 most common therapeutic combinations were a tumor necrosis factor inhibitor plus apremilast (34%–37%) and an interleukin-17 inhibitor plus apremilast (27%–29%).

Notably, the serious infection incidence rate among patients receiving combination targeted therapy ranged from 7.38–15.00 events per 1,000 patients, while the opportunistic infection incidence rate ranged from 0–1.85 events per 1,000 patients. However, patients receiving combination targeted therapy did not have a significantly increased risk of serious infection or opportunistic infection across all analyses.

“The results of this cohort study suggest that, among commercially insured adults with PsA, around 1% of individuals were receiving combination targeted therapy,” conclude the authors. “The most common combinations used different biologics with apremilast. This study found no significant difference between the incidence of serious bacterial and opportunistic infections requiring hospitalization compared with standard therapy, suggesting that combination targeted therapy may not be associated with significantly increased infection risk, but further larger studies are needed.”

Reference

1.     Wu A, Zhang A, Guo Y, et al. Comparative risk of infection and prevalence of combination targeted therapy in psoriatic arthritis. JAMA Dermatol. 2025:e252980.