Observational studyRheumatology (Oxford, England)2023
Is the risk of infection higher during treatment with secukinumab than with TNF inhibitors? An observational study from the Nordic countries.
Observational study in Rheumatology (Oxford, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 13 citations in OpenAlex.
- Efficacy and safety of pharmacological treatment of psoriatic arthritis: a systematic literature research informing the 2023 update of the EULAR recommendations for the management of psoriatic arthritis.Annals of the rheumatic diseases · 2024Pooled it
- Pooled it
- Adverse events associated with candida infections in secukinumab treatment.BMC infectious diseases · 2026Article
- Long-term comparative analysis of secukinumab versus TNFα inhibitors in patients with spondyloarthritis: treatment persistence is differentially affected by disease phenotype, obesity and sex.Arthritis research & therapy · 2025Article
- Adverse Events and Immune Response in Psoriasis Patients Receiving Interleukin-17 Inhibitors.Acta dermato-venereologica · 2025Article
- Longitudinal risk of serious infections in patients with inflammatory arthritis on immunomodulating therapy compared to controls.Rheumatology advances in practice · 2025Article
- Interleukin family in vascular calcification: molecular mechanisms and therapeutic perspectives.Frontiers in cardiovascular medicine · 2025Review
- Selective JAK-Inhibitors in Spondyloarthritis.Mediterranean journal of rheumatology · 2024Review
- Researchers in rheumatology should avoid categorization of continuous predictor variables.BMC medical research methodology · 2023Article
Corrections and comments
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Authors and funding
15 authors at 9 institutions in 6 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe positioning of secukinumab in the treatment of axial SpA (axSpA) and PsA is debated, partly due to a limited understanding of the comparative safety of the available treatments. We aimed to assess the risk of the key safety outcome infections during treatment with secukinumab and TNF inhibitors (TNFi).
methodsPatients with SpA and PsA starting secukinumab or TNFi year 2015 through 2018 were identified in four Nordic rheumatology registers. The first hospitalized infection during the first year of treatment was identified through linkage to national registers. Incidence rates (IRs) with 95% CIs per 100 patient-years were calculated. Adjusted hazard ratios were estimated through Cox regression, with secukinumab as the reference. Several sensitivity analyses were performed to investigate confounding by indication.
resultsAmong 7708 patients with SpA and 5760 patients with PsA, we identified 16 229 treatment courses of TNFi (53% bionaïve) and 1948 with secukinumab (11% bionaïve). For secukinumab, the first-year risk of hospitalized infection was 3.5% (IR 5.0; 3.9-6.3), compared with 1.7% (IR 2.3; 1.7-3.0) during 3201 courses with adalimumab, with the IRs for other TNFi lying in between these values. The adjusted HR for adalimumab, compared with secukinumab, was 0.58 (0.39-0.85). In sensitivity analyses, the difference from secukinumab was somewhat attenuated and in some analyses no longer statistically significant.
conclusionWhen used according to clinical practice in the Nordic countries, the observed first-year absolute risk of hospitalized infection was doubled for secukinumab compared with adalimumab. This excess risk seemed largely explained by confounding by indication.
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