A nationwide study of more than 18,000 patients with psoriasis has found that infection risks vary across systemic treatments, with IL-17 inhibitors linked to a higher risk of candidiasis, while tuberculosis and meningitis remained rare.
A large study of patients with psoriasis has highlighted differences in infection risks associated with commonly used systemic treatments. The research, which covered 18,635 adults in a nationwide cohort, examined how often patients developed tuberculosis, meningitis, and fungal infections during treatment.
The study was conducted using data collected between 2007 and 2024, covering 40,930 treatment episodes and 118,018 person-years of follow-up. Researchers followed adults with psoriasis from the start of their treatment until treatment discontinuation, death, or the end of available follow-up.
The research team assessed infection rates across different treatment groups, including tumour necrosis factor alpha (TNF-α) inhibitors, IL-17 inhibitors, and other systemic therapies. Statistical models were used to compare infection risks between treatments.
IL-17 Inhibitors Linked to Higher Candidiasis Risk
During the study period, researchers recorded 22 cases of tuberculosis, 29 cases of meningitis, and 888 fungal infections, including 450 cases of candidiasis.
Tuberculosis and meningitis remained uncommon, with incidence rates of 0.19 and 0.25 cases per 1,000 person-years, respectively. Most tuberculosis and meningitis cases were linked to TNF-α inhibitors, particularly adalimumab. Tuberculosis cases were mainly pulmonary, while meningitis cases were mostly viral.
Patients receiving IL-17 inhibitors showed a higher risk of candidiasis compared with those using other systemic treatments. The increased risk ranged from 2.67 times higher than with apremilast to 4.65 times higher than with IL-12/23 inhibitors.
Researchers found no significant differences in candidiasis risk between individual IL-17 inhibitors. They also reported no statistically significant differences between treatment groups for fungal infections other than candidiasis.
Longer Monitoring Needed
The researchers said tuberculosis and meningitis were rare among patients receiving systemic psoriasis treatments. However, they noted that longer follow-up would be needed to better understand the risks associated with newer therapies.
The findings highlight the importance of understanding the different infection profiles of psoriasis treatments, particularly the increased candidiasis risk associated with IL-17 inhibitors.
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