New analyses from BADBIR explore infection risk, earlier biologic use, erythrodermic psoriasis and the wider value of real-world evidence in dermatology.
At this year’s British Association of Dermatologists (BAD) Annual Meeting, several oral presentations highlighted new real-world insights from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR), exploring important questions around the treatment of psoriasis.
The discussion covers infection risk comparisons across systemic psoriasis treatments, the potential role of biologics as first-line systemic therapy and emerging evidence on risk factors for erythrodermic psoriasis. We also discuss the wider value of real-world evidence, such as that collected from BADBIR, and the need to improve research inclusion across routinely collected and observational datasets.
BADBIR
Q. What is BADBIR, and why is it such an important resource for understanding psoriasis treatment?
The British Association of Dermatologists Biologics and Immunomodulators Register, or BADBIR, was established as a UK pharmacovigilance registry for people living with psoriasis who have started systemic or biologic therapy. It includes different patient cohorts: one for people with moderate-to-severe disease receiving traditional systemic therapies, one for those receiving biologics and one for those receiving small molecule therapies, with the key aim of the register being to establish the long-term safety of medicines used to treat psoriasis.
However, since its establishment in 2007, the BADBIR registry has grown considerably and now provides much more than safety data alone. For example, it has been used to explore treatment effectiveness and whether earlier use of biologic therapy could make a difference. Looking ahead, this rich dataset may also help improve our understanding of the health economics of psoriasis and support better modeling of the most effective ways to treat the condition.
Serious infection risk with systemic treatment
Q. One analysis looked at infection risk among patients receiving systemic treatments for psoriasis. What was the rationale for this study, and what were the key findings?
Infection was one of the key predefined outcomes for BADBIR. We know immunomodulators target the immune system, and that as a result they can potentially increase the risk of infection. From the outset, we were therefore interested in understanding whether some treatments were associated with a higher or lower risk of infection, and how this information could help direct patient care.
The topline findings were that across the different biologic treatments studied, infliximab appeared to be associated with a higher risk of serious infection. These are infections that result in hospitalization, severe morbidity or mortality. These findings may partly reflect the fact that infliximab is often used in patients with more severe disease, but it may also relate to the way the drug is often used as an intravenous treatment. Importantly, this higher infection signal has been noted previously and has also been replicated across other datasets.
When comparing other treatments, we found that rizankizumab, an IL-23 inhibitor, appeared to be associated with a lower risk of serious infection compared with several other treatments. This echoes some of the signals seen in clinical trials and is also consistent with what we know about the mechanism of IL-23 inhibitors. In that sense, these findings provide real-world validation of some of the patterns observed in clinical trial data.
→ Abstract: Bright HRB, Smith CH, Laws P, et al. Serious infection risk with systemic treatments for psoriasis: A cohort study from the British Association of Dermatologists Biologic Interventions Register (BADBIR). Br J Dermatol. 2026 May 5:ljag174. doi: 10.1093/bjd/ljag174. Epub ahead of print.
Biologic therapies as first-line systemic treatment
Q. BADBIR data was also used to explore biologics as a first-line systemic therapy in psoriasis. What led to the hypothesis that earlier biologic intervention might improve longer-term outcomes and what did the analysis reveal?
I think one of the key changes has been the cost of biologic treatments, particularly with the introduction of biosimilars. We now have biosimilars available for adalimumab and ustekinumab, and potentially in the future for secukinumab. This has really changed the unit cost of treating moderate-to-severe psoriasis.
However, in the UK and the Republic of Ireland the pathways and guidelines are all established and predicated on the NICE technology appraisals of the past. For example, the appraisal for adalimumab was back in 2009 when only one company was producing one particular product. And so the paradigm has changed, but the pathway hasn’t.
Now that lower-cost biosimilar options are available, we want to better define the benefits of using a biologic from the start of treatment rather than requiring patients to first move through the traditional systemic treatments such as methotrexate or cyclosporin.
What we found was that there were consistent benefits of initiating biologics as a first systemic therapy across several markers of clinical effectiveness. This included improvements in PASI, the proportion of patients achieving complete skin clearance, the time taken to achieve complete clearance and the accumulation of chronic comorbid conditions. Across these measures, we found a benefit for using biologics earlier compared with the current standard of care.
We hope these results provide an additional piece of evidence to help demonstrate to commissioners why earlier use of biologics may be beneficial.
→ Abstract: Phan DB, Laws P, Smith CH et al. Using biologic therapies as first-line systemic treatment for psoriasis: A cohort study following the target trial emulation framework from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). Br J Dermatol. 2026 Mar 16:ljag098. doi: 10.1093/bjd/ljag098. Epub ahead of print.
Q. What further research is needed to support the use of biologics as a first-line treatment for psoriasis?
The key piece of evidence we still need is the health economic argument. We need to understand how much could be saved, and what the exact financial benefits might be, if biologics were used earlier in the treatment pathway.
It is also important to define what we mean by earlier treatment more broadly. This is not only about using biologics earlier, but about treating earlier in the disease course and understanding where intervention may have the greatest impact.
From the biological data, as well as what we see in the clinic, there is a rationale for intervening when patients first develop, or are first diagnosed with, psoriasis. If we can treat it earlier, we may be more likely to switch off the inflammatory process, including the activity of resident memory T cells, and potentially change the course of the disease. What we now need now is the data to support that.
Risk factors for erythrodermic psoriasis
Q. Data was presented on risk factors for erythrodermic psoriasis. What is erythrodermic psoriasis and why is identifying risk factors so important?
Erythrodermic psoriasis is a rarer subtype of psoriasis in which patients develop widespread redness across most of the body, rather than discrete plaques. Identifying risk factors is crucial because erythrodermic psoriasis can lead to skin failure, which can be life-threatening. In this situation, the skin is no longer able to perform key protective functions, such as regulating temperature and retaining water.
Better understanding which patients develop this subtype, including why some people progress to erythrodermic psoriasis despite treatment, may help identify clinical biomarkers, improve understanding of the underlying mechanisms and support better prevention and treatment strategies.
Q. What did the analysis reveal about determinants of erythrodermic psoriasis?
One of the most interesting findings was that alcohol appeared to be a consistent signal across the analysis. We examined both incident erythrodermic psoriasis, in people who had not previously had this subtype, and recurrent erythrodermic psoriasis, in those with a previous history of the condition. In both groups, alcohol appeared to be a consistent factor.
There is also some signal that it may be associated with pustular psoriasis. There is a concept of pustulation in psoriasis versus generalized pustular psoriasis, and there may be some overlapping mechanisms that push people with plaque psoriasis to become erythrodermic and potentially also develop pustulation.
We already know that people with erythrodermic psoriasis have a more mixed inflammatory picture. It is not just the Th17 pathway that is activated; Th2 and other pathways may also be involved. This provides one more piece of clinical data to help us better understand the condition.
→ Abstract: Ali Al-Janabi, Oras Alabas, Catherine Smith, et al. O10 Risk factors for incident and recurrent erythrodermic psoriasis: cohort analyses from the British Association of Dermatologists Biologics and Immunomodulators Register, British Journal of Dermatology, Volume 195, Issue Supplement_1, June 2026, ljag086.025, https://doi.org/10.1093/bjd/ljag086.025
Dermatology registries and research inclusion
Q. During the diversity in dermatology session, you delivered a talk on dermatology registries and research inclusion. Could you tell us about the aim of the talk and the key take-home messages?
The aim of the talk was to highlight the importance of routinely collected and observational data alongside clinical trials, and how these data can help us better understand patient populations that more closely reflect the diversity of those we see in everyday clinical practice.
One of the key challenges within registries is research inclusion. This is something we need to work hard to improve across all types of research, including routinely collected and observational data.
We know that we are probably underestimating and under-collecting data from minority populations. Across the protected characteristics, we may be more aware of factors such as ethnicity and socioeconomic status, but there are many others that we do not routinely collect enough information on, such as disability or marital status.
The aim of the talk was to highlight the importance of this for the audience, particularly as potential principal investigators or researchers. We need to think about how we can include a diverse population that reflects the people we see in clinic, invite them to participate in research and consider the obstacles they may face. These might include language barriers, time constraints or childcare responsibilities. We also need to think about practical ways we can help overcome these barriers.
I hope that I was able to really shine a light on this issue and encourage us, as a field, to improve the quality and inclusivity of the data we collect, including in routinely collected research.
→ Presentation: Yiu Z. Dermatology registries and research inclusion. SIG – Diversity in Dermatology session. BAD 2026. June 30, 2026.
Disclosures: Zenas Yiu reports serving as a speaker for UCB and LEO Pharma on an unpaid basis and on an advisory board for Takeda without receiving an honorarium.
BADBIR is funded by the British Association of Dermatologists (BAD). The BAD receives income from AbbVie, Almirall, Amgen, Bristol Myers Squibb, Boehringer Ingelheim, Eli Lilly, Janssen, LEO Pharma, Novartis, Samsung Bioepis and UCB Pharma for the provision of pharmacovigilance services. This income supports a separate contract between the BAD and the University of Manchester, which coordinates BADBIR.
This content has been developed by Touch Medical Media for touchDERMATOLOGY in collaboration with Dr Yiu . It is not affiliated with the British Academy of Dermatology (BAD). Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.
Editor: Gina Furnival
Cite: BADBIR data offer real-world insights into psoriasis treatment and risk factors. TouchDERMATOLOGY. July XX, 2026
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