BACKGROUND Psoriasis is increasingly treated with systemic medications, yet their safety is not well characterized in children. OBJECTIVE We sought to estimate the 6-month risk of serious infections in children with psoriasis treated with biologics, systemic nonbiologics, and phototherapy. METHODS Using insurance claims data, we identified children aged <18 years with psoriasis and compared the frequency of serious infections in those initiating biologics, systemic nonbiologics, and phototherapy. Relative risks were estimated before and after 1:1 propensity score matching. RESULTS Among 57,323 children with psoriasis, the 6-month risk of infection was 4.2 per 1000 patient-years in 722 biologic initiators, 5.1 in 988 systemic nonbiologic initiators, and 1.1 in 2657 phototherapy initiators. The relative risk (95% confidence interval) of infection in biologics vs nonbiologics was 0.67 (0.11-3.98), in biologics vs phototherapy was 1.50 (0.25-8.95), and in nonbiologics vs phototherapy was 5.00 (0.59-42.71). The background risk of infection in children with psoriasis was 1 per 1000, almost double the risk compared with children without psoriasis (relative risk, 1.84; 95% confidence interval, 1.15-1.97). CONCLUSIONS We found no meaningful difference in infection risk between biologics vs nonbiologics and no robust difference between systemic users vs phototherapy. Independent of treatment, children with psoriasis had a higher risk of infection than those without psoriasis.

中文翻译：

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接受全身治疗的银屑病儿童的严重感染风险：倾向评分匹配的基于人群的研究。

背景越来越多地使用全身性药物治疗银屑病，但它们在儿童中的安全性并未得到很好的表征。目的 我们试图估计接受生物制剂、全身性非生物制剂和光疗治疗的银屑病儿童 6 个月内发生严重感染的风险。方法 使用保险理赔数据，我们确定了年龄小于 18 岁的银屑病儿童，并比较了那些开始使用生物制剂、全身性非生物制剂和光疗的严重感染频率。在 1:1 倾向评分匹配之前和之后估计相对风险。结果 在 57,323 名银屑病儿童中，722 名生物制剂患者的 6 个月感染风险为每 1000 患者年 4.2，988 名全身性非生物制剂患者为 5.1，2657 名光疗患者为 1.1。生物制剂与非生物制剂感染的相对风险（95% 置信区间）为 0.67 (0.11-3.98)，生物制剂与光疗为 1.50 (0.25-8.95)，非生物制剂与光疗为 5.00 (0.59-42.71)。银屑病儿童感染的背景风险为千分之一，几乎是无银屑病儿童的两倍（相对风险，1.84；95% 置信区间，1.15-1.97）。结论 我们发现生物制剂与非生物制剂之间的感染风险没有显着差异，全身使用者与光疗之间也没有明显差异。独立于治疗，患有银屑病的儿童比没有银屑病的儿童有更高的感染风险。银屑病儿童感染的背景风险为千分之一，几乎是无银屑病儿童的两倍（相对风险，1.84；95% 置信区间，1.15-1.97）。结论 我们发现生物制剂与非生物制剂之间的感染风险没有显着差异，全身使用者与光疗之间也没有明显差异。独立于治疗，患有银屑病的儿童比没有银屑病的儿童有更高的感染风险。银屑病儿童感染的背景风险为千分之一，几乎是无银屑病儿童的两倍（相对风险，1.84；95% 置信区间，1.15-1.97）。结论 我们发现生物制剂与非生物制剂之间的感染风险没有显着差异，全身使用者与光疗之间也没有明显差异。独立于治疗，患有银屑病的儿童比没有银屑病的儿童有更高的感染风险。