Psoriasis Treatment And Infection Risk: Why IL-17 Inhibitors Stand Out

Systemic treatments for psoriasis showed different infection risk profiles in a nationwide cohort study involving 18,635 patients.

Researchers found that tuberculosis and meningitis remained rare, while candidiasis occurred more frequently among patients receiving interleukin (IL)-17 inhibitors.

The study included 40,930 treatment episodes and 118,018 person-years of follow-up between 2007 and 2024.

Researchers followed adults with psoriasis from the start of systemic treatment until treatment discontinuation, death or the last available follow-up.

The researchers assessed tuberculosis, meningitis, candidiasis and other fungal infections. They calculated incidence rates and incidence rate ratios using adjusted statistical models to compare infection risks across treatment groups.

During the follow-up period, researchers recorded 22 tuberculosis cases, 29 meningitis cases and 888 fungal infections, including 450 cases of candidiasis.

The overall incidence rates per 1,000 person-years were 0.19 for tuberculosis, 0.25 for meningitis and 7.53 for fungal infections.

Most tuberculosis and meningitis cases occurred among patients receiving tumour necrosis factor-alpha (TNF-α) inhibitors, particularly adalimumab.

Tuberculosis cases were mainly pulmonary, while meningitis cases were predominantly viral. Fewer than five meningitis cases were linked to death within 30 days.

The study found a higher risk of candidiasis among patients receiving IL-17 inhibitors compared with other systemic treatment groups.

Incidence rate ratios ranged from 2.67 compared with apremilast to 4.65 compared with IL-12/23 inhibitors.

Researchers did not find significant differences in candidiasis risk between individual IL-17 inhibitors. They found no statistically significant differences between treatment groups for fungal infections other than candidiasis.

The researchers concluded that tuberculosis and meningitis remained uncommon among patients receiving systemic psoriasis treatments. They noted that longer follow-up would help better assess infection risks associated with newer therapies.

Candidiasis and other fungal infections were more common overall, with IL-17 inhibitors showing a higher candidiasis risk.

The findings highlight differences in infection profiles across systemic psoriasis treatments and may help inform monitoring during treatment.

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