JAMA Dermatol

Combination therapy in psoriatic arthritis shows no added infection risk

August 27, 2025

Study details: This retrospective cohort study analyzed data from the IBM MarketScan Commercial Claims Database (2015–2024) to assess infection risk in adults with psoriatic arthritis (PsA) receiving combination targeted therapy (CTT). Among 82,399 individuals with PsA, 542 received CTT for ≥3 months and 200 for ≥6 months. CTT was defined as overlapping use of ≥2 biologics or targeted synthetic disease-modifying antirheumatic drugs (DMARDs). The most common combinations included TNF inhibitors or IL-17 inhibitors with apremilast.

Results: CTT was associated with low infection rates among patients with PsA. The incidence of serious infections ranged from 7.38 to 15.00 events per 1,000 patients, while opportunistic infections occurred at rates between 0 and 1.85 per 1,000. Importantly, CTT didn’t significantly increase infection risk compared with standard therapy. At three months, the relative risk (RR) for serious infection was 0.53 (95% confidence interval [CI], 0.17–1.63), and at six months, RR was 1.50 (95% CI, 0.34–6.65). For opportunistic infections, the adjusted RR at 3 months was 1.00 (95% CI, 0.09–11.02), with no applicable data at six months.

Clinical impact: Despite historical concerns, combining targeted therapies in PsA, especially with apremilast, didn’t increase infection risk in this large claims-based analysis. These findings may support cautious expansion of combination approaches in refractory PsA cases, though further studies are needed to confirm safety across broader populations and drug combinations.

Source:

Wu A, et al. (2025, August 20). JAMA Dermatol. Comparative Risk of Infection and Prevalence of Combination Targeted Therapy in Psoriatic Arthritis. https://pubmed.ncbi.nlm.nih.gov/40833728/