Daijiworld Media Network - New Delhi
New Delhi, Sep 24: Systemic treatments for psoriasis were associated with differing infection risk profiles, with candidiasis occurring more frequently among patients receiving interleukin-17 (IL-17) inhibitors, according to findings from a nationwide cohort study.
The study included 18,635 adults with psoriasis who underwent 40,930 systemic treatment episodes, contributing 118,018 person-years of follow-up between 2007 and 2024. Patients were followed from the start of treatment until discontinuation, death or the end of available follow-up.
Researchers assessed the occurrence of tuberculosis, meningitis, candidiasis and other fungal infections, calculating incidence rates and comparing risks across different systemic treatment groups.
During the follow-up period, 22 cases of tuberculosis, 29 cases of meningitis and 888 fungal infections were recorded, including 450 cases of candidiasis. The 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 largely pulmonary, while meningitis cases were predominantly viral. Fewer than five meningitis cases were associated with death within 30 days.
Patients receiving IL-17 inhibitors had a higher risk of candidiasis compared with those receiving other systemic treatments. The incidence rate ratios ranged from 2.67 compared with apremilast to 4.65 compared with IL-12/23 inhibitors.
The researchers found no significant differences in candidiasis risk among individual IL-17 inhibitors. There were also no statistically significant differences between treatment groups for fungal infections other than candidiasis.
The study concluded that tuberculosis and meningitis remained rare among patients receiving systemic psoriasis treatments, although longer follow-up would be required to better understand the risks associated with newer therapies.
Candidiasis and other fungal infections were more common, with the increased candidiasis risk among IL-17 inhibitor users highlighting differences in infection profiles across systemic psoriasis treatments.