Abstract
Background: The risk of infections among patients with psoriasis undergoing interleukin (IL)-23 inhibitors (IL-23i) and IL-17 inhibitors (IL-17i) is yet to be exhaustively determined. Objective: To assess the risk of infectious complications in patients with psoriasis managed by IL-23i and IL-17i with tumour necrosis factor inhibitors (TNFi) as a comparator. Methods: A global cohort study comprised two distinct analyses comparing patients with psoriasis under different therapeutic modalities; (i) new users of IL-23i (n = 5272) versus TNFi (n = 5272) and (ii) new users of IL-17i (n = 15,160) versus TNFi (n = 15,160). Study groups were compared regarding the risk of 26 different infections. Propensity score matching was conducted to optimize between-group comparability. Results: Patients under IL-23i had a lower risk of otitis media (HR, 0.66; 95% CI, 0.44–0.97), encephalitis (HR, 0.18; 95% CI, 0.04–0.78), herpes zoster (HZ; HR, 0.58; 95% CI, 0.41–0.82), hepatitis B virus (HBV) reactivation (HR, 0.24; 95% CI, 0.12–0.47), cytomegalovirus (HR, 0.25; 95% CI, 0.07–0.86), influenza (HR, 0.52; 95% CI, 0.38–0.71) and parasitic diseases (HR, 0.78; 95% CI, 0.64–0.95). IL-17i was associated with a decreased risk of pneumonia (HR, 0.76; 95% CI, 0.68–0.85), septicaemia (HR, 0.84; 95% CI, 0.72–0.97), upper respiratory tract infection (HR, 0.84; 95% CI, 0.77–0.92), HZ (HR, 0.79; 95% CI, 0.67–0.92), HBV (HR, 0.59; 95% CI, 0.46–0.76) and hepatitis C virus (HR, 0.71; 95% CI, 0.57–0.88) reactivation, cytomegalovirus (HR, 0.58; 95% CI, 0.36–0.93), Epstein–Barr virus (HR, 0.38; 95% CI, 0.19–0.75), influenza (HR, 0.70; 95% CI, 0.61–0.81) and parasitic diseases (HR, 0.80; 95% CI, 0.72–0.88). Conclusion: Compared with TNFi, IL-23i and IL-17i are associated with decreased risk of several infectious diseases. These agents might be preferred in patients with susceptibility to infections.
| Original language | English |
|---|---|
| Pages (from-to) | 2319-2326 |
| Number of pages | 8 |
| Journal | Journal of the European Academy of Dermatology and Venereology |
| Volume | 37 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 2023 |
Bibliographical note
Publisher Copyright:© 2023 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.
Funding
KK and RJL had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Open Access funding enabled and organized by Projekt DEAL.
