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October 31, 2025Dermatology and TherapyOpen Access

Serious Infection Risk with Systemic Treatments for Psoriasis: A Systematic Review and Network Meta-analysis Combining Randomised and Non-randomised Evidence

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Authors

HBHeber Rew BrightManchester Academic Health Science CentreDPDuc Binh PhanManchester Academic Health Science CentreLALeila Motedayеn AvalImperial College Healthcare NHS Trust

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Implication

Systematic review and network meta-analysis reports elevated serious infection risks with infliximab and adalimumab in psoriasis patients, highlighting the need for vigilant safety surveillance.

Key Points

  • To evaluate and compare the risk of serious infections associated with systemic and targeted therapies in patients with plaque psoriasis.
  • Conducted a systematic review of Medline, Embase, Cochrane register, CINAHL, and ClinicalTrials.gov through September 2024 for RCTs and non-randomized studies of interventions (NRSIs) evaluating systemic psoriasis treatments in ≥50 patients.
  • Synthesized data from 76 RCTs (n = 39,044) reporting serious infections and 6 NRSIs lacking critical bias (n = 306,762) using frequentist random-effects network meta-analysis across RCT, NRSI, and combined models.
  • The RCT network showed no significant difference in serious infection risk across any drug or drug class when compared with each other.
  • The NRSI network showed a significantly higher risk of serious infections for infliximab versus methotrexate (IRR 2.85; 95% CI 1.48, 5.46) and adalimumab versus ustekinumab (IRR 1.51; 95% CI 1.25, 1.83).
  • Combined network analyses revealed significantly higher serious infection risks for both infliximab and adalimumab compared to acitretin, bimekizumab, methotrexate, placebo, risankizumab, and secukinumab.

Cite This Study

Bright et al. (2025) studied this question.

synapsesocial.com/papers/6a803bbc0190ac0812701518https://doi.org/10.1007/s13555-025-01578-w
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Quantifying heterogeneity in a meta‐analysis2002 · 37,607 citations
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  5. 5Ranking treatments in frequentist network meta-analysis works without resampling methods2015 · 1,817 citations