What question did this study set out to answer?

The aim was to assess the infection risk in patients with ankylosing spondylitis and psoriatic arthritis treated with biologic drugs compared to conventional treatments.

June 4, 2026Open Access

Biologics reduced infections in ankylosing spondylitis and psoriatic arthritis under immunosuppressants

Key Points

The aim was to assess the infection risk in patients with ankylosing spondylitis and psoriatic arthritis treated with biologic drugs compared to conventional treatments.
Retrospective analysis of 5,568 patients with spondyloarthritis using hospital database data from January 2011 to September 2018.
Verification of serious infections requiring hospitalization through a two-step process.
Time-to-event outcomes were assessed using multivariable Cox regression, adjusting for age, sex, and comorbidities.
bDMARD prescription significantly reduced the risk of first serious infection in the overall cohort (aHR 0.247, P=2.4782 x 10 -7).
Significant reduction of serious infection risk was observed in ankylosing spondylitis (aHR 0.253, P=4.73 x 10 -4) and psoriatic arthritis (aHR 0.207, P=6.69 x 10 -4).
Sulfasalazine was associated with increased infection risk (aHR 1.630, P=2.6276 x 10 -2), while nonsteroidal anti-inflammatory drugs lowered risk in AS.

Abstract

BACKGROUND: Biologic disease-modifying antirheumatic drugs (bDMARDs) alleviate inflammation but may have immunocompromising effects. Previous studies evaluating infection risks in spondyloarthritis (SpA) have yielded inconsistent conclusions. We investigated infection risk in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) receiving bDMARDs compared with that of those receiving only conventional synthetic disease-modifying antirheumatic drugs. METHODS: Using the database at Taipei Veterans General Hospital (from January 1, 2011, to September 30, 2018), we retrospectively identified eligible SpA patients and applied a two-step verification process to confirm serious infections requiring hospitalization. Time-to-event outcomes were analyzed using multivariable Cox regression adjusted for age, sex, comorbidities, and concomitant medications. Site-specific analysescharacterized infection patterns. RESULTS: We included 5,568 patients with SpA (4,784 AS, 784 PsA), with a mean age of 42.1 years and male predominance (68.4%). bDMARD prescription was associated with a reduced risk of first serious infection in the overall SpA cohort (adjusted hazard ratio aHR 0.247, P=2.4782 x 10 -7), as well as in AS (aHR 0.253, P =4.73 x 10 -4) and PsA (aHR 0.207, P=6.69 x 10 -4). bDMARD prescription was also associated with significantly lower risks of skin and soft tissue infection risks in PsA (aHR 0.252, P=1.1905 x 10 -2) and pneumonia/gastrointestinal infections in SpA. Sulfasalazine (SSZ) was independently associated with an increased infection risk (aHR 1.630, P=2.6276 x 10 -2); nonsteroidal anti-inflammatory drugs were associated with a reduced risk in AS. CONCLUSION: Adjunctive bDMARD therapy was associated with a substantially reduced risk of serious infection in AS, PsA and the overall SpA cohort, potentially because of effective systemic inflammation suppression in SpA and skin restoration barrier in PsA. The elevated risk associated with SSZ in AS may reflect channeling bias in refractory patients. Early and appropriate use of bDMARDs in SpA may achieve disease control without compromising immune defense against infections.

Biologics reduced infections in ankylosing spondylitis and psoriatic arthritis under immunosuppressants

Key Points

Abstract

Cite This Study

Also Consider

Also Consider