Evidence mapPaperPMID 42226077Full record

ArticleJournal of the Chinese Medical Association : JCMA2026

Biologics reduced infections in ankylosing spondylitis and psoriatic arthritis under immunosuppressants.

Hsiang-Yuen Tung, Hsien-Tzung Liao, Chung-Ching Wang, Wei-Liang Chen, Chang-Youh Tsai

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Article in Journal of the Chinese Medical Association : JCMA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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5 authors.

Hsiang-Yuen TungGraduate Institute of Life Sciences, College of Biomedical Sciences, National Defense Medical University, Taipei, Taiwan, ROC.
Hsien-Tzung LiaoDivision of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Chung-Ching WangDivision of Environmental Health and Occupational Medicine, Department of Family Medicine and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Wei-Liang ChenGraduate Institute of Life Sciences, College of Biomedical Sciences, National Defense Medical University, Taipei, Taiwan, ROC.
Chang-Youh TsaiGraduate Institute of Life Sciences, College of Biomedical Sciences, National Defense Medical University, Taipei, Taiwan, ROC.ORCID 0000-0002-4154-4018

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No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBiologic disease-modifying antirheumatic drugs (bDMARDs) alleviate inflammation but may have immunocompromising effects. Previous studies evaluating infection risks in spondyloarthritis (SpA) have yielded inconsistent conclusions. We investigated infection risk in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) receiving bDMARDs compared with that of those receiving only conventional synthetic disease-modifying antirheumatic drugs.

methodsUsing the database at Taipei Veterans General Hospital (from January 1, 2011, to September 30, 2018), we retrospectively identified eligible SpA patients and applied a two-step verification process to confirm serious infections requiring hospitalization. Time-to-event outcomes were analyzed using multivariable Cox regression adjusted for age, sex, comorbidities, and concomitant medications. Site-specific analyses characterized infection patterns.

resultsWe included 5568 patients with SpA (4,784 AS, 784 PsA), with a mean age of 42.1 years and male predominance (68.4%). bDMARD prescription was associated with a reduced risk of first serious infection in the overall SpA cohort (adjusted hazard ratio [aHR] = 0.247, p = 2.4782 × 10 -7 ), as well as in AS (aHR = 0.253, p = 4.73 × 10 -4 ) and PsA (aHR = 0.207, p = 6.69 × 10 -4 ). bDMARD prescription was also associated with significantly lower risks of skin and soft tissue infection in PsA (aHR = 0.252, p = 1.1905 × 10 -2 ) and pneumonia/gastrointestinal infections in SpA. Sulfasalazine (SSZ) was independently associated with an increased infection risk (aHR = 1.630, p = 2 .6276 × 10 Sulfasalazine 2 ); nonsteroidal anti-inflammatory drugs were associated with a reduced risk in AS.

conclusionAdjunctive bDMARD therapy was associated with a substantially reduced risk of serious infection in AS, PsA, and the overall SpA cohort, potentially because of effective systemic inflammation suppression in SpA and restoration of the skin barrier in PsA. The elevated risk associated with SSZ in AS may reflect channeling bias in refractory patients. Early and appropriate use of bDMARDs in SpA may achieve disease control without compromising immune defense against infections.

Indexed as

Antirheumatic AgentsArthritis, PsoriaticBiological ProductsImmunosuppressive AgentsInfectionsSpondylitis, AnkylosingAdultFemaleHumansMaleMiddle AgedRetrospective StudiesAntirheumatic AgentsBiological ProductsImmunosuppressive AgentsAnkylosing spondylitisBiological disease-modifying antirheumatic drugsConventional synthetic disease-modifying antirheumatic drugsPneumoniaPsoriatic arthritisSpondyloarthritis

Identifiers

PMID42226077
PMCPMC13387758

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.