Patients with HS on Adalimumab At Greater Risk of Infection Versus Patients with Psoriasis

Adults with moderate to severe hidradenitis suppurativa (HS) treated with adalimumab may have an increased risk of infection, new data suggest, though infection profiles differ with those with psoriasis.1

These findings resulted from a recently published analysis in JAMA, authored by investigators such as Bruna Galvao de Oliveira Wafae, MD, MMSc, from the Brigham and Women’s Hospital Department of Dermatology. Wafae and coauthors sought to explore the differences between the risk of serious infection in adalimumab users with HS and psoriasis.

The team highlighted that despite recent data suggesting an increase in the prevalence of systemic infections among those with HS versus psoriasis, such research was limited as it did not adjust for individual risk factors.2

“Therefore, our study aims to compare the risk of hospitalization from noncutaneous infections (NCIs), the infection profiles, and the length of stay for these infections between HS and psoriasis, thus providing a more focused evaluation of the HS-specific infection burden,” Wafae and colleagues wrote.1

Trial Design and Findings

The investigative team's retrospective cohort study implemented deidentified insurance claims that were drawn from the MarketScan database. The team sought to assess outcomes among adult patients diagnosed with HS or psoriasis who began treatment with adalimumab therapy in the timeframe between January 2017 - December 2020. The analysis period spanned from October 2023 - March 2024.

Wafae et al compared risk of hospitalization as a result of non-cutaneous infections. They also compared patterns of infection and length of hospital stay (LOS) between the 2 patient cohorts. The study's primary endpoint the occurrence of non-cutaneous infection–related hospitalizations. These were assessed with time-to-event analysis along with Cox regression models adjusted using inverse probability weighting to reduce any confounders.

The investigators' secondary endpoints involved assessment of infection subtypes through the use of incidence rate ratios (IRRs) and LOS with multivariable Poisson regression. There were 10,349 individuals included in Wafae and colleagues' study, with the mean age being 44.8 years and 54.5% being labeled as female. The cohort comprised 1650 subjects living with HS and 8699 living with psoriasis.

The investigative team found in their assessment that when compared to individuals with psoriasis, those who had HS were younger. Specifically, they had a mean age of 36.2 years versus 46.5 years for those with psoriasis. The team also found those with HS were more often female (77.0% versus 50.2%). They also exhibited higher rates of Crohn disease, obesity, anxiety, and depression.

Overall, Wafae and coauthors' weighted Cox regression results demonstrated that HS was linked with a greater risk of serious infection compared with psoriasis (hazard ratio [HR], 1.53; 95% CI, 1.34–1.86).1 Additionally, the study subjects with HS also showed significantly increased rates of genitourinary infections (IRR, 2.22; 95% CI, 1.22–3.86) and sepsis (IRR, 2.07; 95% CI, 1.35–3.12). They were also shown to have an increased odds of extended hospitalization (odds ratio [OR], 1.28; 95% CI, 1.13–1.45).

“Future studies will be important to further understand the risk of infection in this population, focusing on the contribution of the disease severity and therapeutic regimens, as well as investigating prophylactic strategies to reduce infection burden in the HS population,” they wrote.1

References

1. Wafae BGDO, Charrow AP, Stein D, Barbieri JS, Noe MH. Risk of Serious Infection With Adalimumab in Hidradenitis Suppurativa Compared With Psoriasis. JAMA Dermatol. Published online August 20, 2025. doi:10.1001/jamadermatol.2025.2881.

2. Lee HH, Patel KR, Singam V, Rastogi S, Silverberg JI. Associations of cutaneous and extracutaneous infections with hidradenitis suppurativa in U.S. children and adults. Br J Dermatol. 2020;182(2):327-334. doi:10.1111/bjd.18093.