Can Tremfya Cause UTIs?
Tremfya (guselkumab) does not directly cause urinary tract infections, but as an immunosuppressive biologic medication, it may increase susceptibility to infections in general, including UTIs, though this is not a prominently reported adverse effect.
Evidence from FDA Drug Labeling
The FDA-approved prescribing information for Tremfya lists infections as a known risk with this medication 11. However, UTIs are not specifically highlighted as a common adverse reaction in the clinical trial data:
- In psoriasis and psoriatic arthritis trials, the most common infections reported were upper respiratory tract infections, not UTIs
- In ulcerative colitis trials, respiratory tract infections occurred in 8.8% of Tremfya-treated patients vs. 7.3% on placebo 11
- The drug label specifically mentions respiratory infections, bronchitis, and fungal skin infections as common infectious complications, but does not list UTIs among the frequently reported adverse events
Clinical Context and Mechanism
Tremfya works by blocking IL-23, which suppresses certain immune pathways 23. This immunosuppression theoretically increases infection risk:
- The FDA label warns about increased risk of infections generally and recommends screening for tuberculosis before treatment 11
- Immunosuppression is a recognized risk factor for complicated UTIs in general medical literature 44
- However, the specific infection profile of Tremfya appears to favor respiratory rather than urinary tract infections based on clinical trial data
Important Caveats
If a patient on Tremfya develops a UTI, this should be evaluated and treated according to standard UTI guidelines 44:
- The UTI is more likely related to other patient-specific risk factors (diabetes, catheterization, anatomical abnormalities) rather than the medication itself
- Standard diagnostic workup with urine culture should be performed 4
- Treatment duration and antimicrobial selection should follow established guidelines for complicated vs. uncomplicated UTI 45
The presence of immunosuppression from Tremfya may warrant consideration of the UTI as "complicated" if it occurs, requiring potentially longer treatment duration and broader antimicrobial coverage 45.