Systemic antibiotic exposure is significantly associated with an increased risk of discontinuation of biologic therapies in patients with psoriasis, a French study has found.
Published as a brief report in JAMA Dermatology [link here], the study underscores the need for “careful antibiotic prescribing” to better support biologic persistence, according to its authors, who say drug interactions, immunologic effects or gut dysbiosis may explain the association, although causality is unproven.
The retrospective study comprised data from 36,129 adults initiating a biologic therapy for psoriasis from January to September 2024.
Findings showed 25.9% of patients were exposed to systemic antibiotics in the 6 months prior to the first biologic dispensation while 60.6% were exposed to antibiotics at least once during the 15 month follow-up period.
The mean number of antibiotic dispensations was 3.7 per patient.
The study found the risk of discontinuing any biologic therapy was associated with any antibiotic use (HR 1.12 for 1 antibiotic; HR 1.29 for ≥2 antibiotics; both p <0.001).
Similarly, the risk of IL-23, IL-17 and anti-TNF inhibitor discontinuation was associated with exposure to ≥1 antibiotics while the risk of IL-12/23 inhibitor discontinuation was only associated with ≥2 antibiotics.
Other variables associated with lower biologic persistence were female sex, obesity, high blood pressure, diabetes, alcohol consumption, respiratory diseases, and PPI use after the first biologic dispensation.
In post hoc analyses, antibiotic dispensations were relatively similar for patients who had a second biologic therapy sequence (n = 19,365), with 10,678 patients (55.1%) exposed to at least 1 antibiotic and a mean of 3.48 antibiotics boxes dispensed per exposed patient.
“In this nationwide cohort, antibiotic exposure was associated with higher risk of biologic discontinuation in psoriasis, with a dose-response relationship and temporal consistency,” the investigators wrote.
“While suggestive, causality cannot be established. Antibiotics may influence treatment persistence through immune modulation or promotion of antidrug antibodies, and dysbiosis remains one of several potential mechanisms.”
They said their findings highlighted the importance of careful antibiotic prescribing in patients receiving biologics as minimising antibiotic exposure may support biologic persistence.
“Further research is warranted to confirm these associations, clarify underlying mechanisms, and identify patient-related and treatment-related factors influencing biologic durability,” they concluded.