IL-17 and IL-23 Inhibitors Reduce Risk for Infection Among Patients with Psoriasis

Compared with TNF inhibitors, IL-17 and IL-23 inhibitors are associated with a decreased risk for several bacterial, viral, and parasitic infections in patients with psoriasis.

Among patients with psoriasis, treatment initiation with interleukin-23 (IL-23) or interleukin-17 (IL-17) inhibitors was associated with a decreased risk for several infectious diseases compared with the use of tumor necrosis factor (TNF) inhibitors, according to study results published in the Journal of the European Academy of Dermatology and Venereology.

In a global, population-based, retrospective cohort study, researchers sourced data from the TriNetX database to evaluate infection risk among patients with psoriasis initiating treatment with IL-23, IL-17, or TNF inhibitors.

The researchers followed patients in the 3 treatment groups longitudinally to evaluate the associated risk for 26 different bacterial, viral, fungal, and opportunistic infections. To balance the study groups, the researchers performed propensity score matching.

The first analysis compared 5272 patients with psoriasis treated with IL-23 inhibitors (mean [SD] age, 49.8 [15.3] years; 53% women) vs 5272 propensity-matched counterparts who received TNF inhibitors (mean [SD] age, 49.4 [15.5] years; 55% women). The second analysis compared 15,160 patients with psoriasis initiating IL-17 inhibitors (mean [SD] age, 50.3 [14.3] years; 58% women) vs 15,160 patients who initiated TNF inhibitors (mean [SD] age, 50.6 [14.7] years; 59% women).

This study suggests a high safety profile of IL-23i and IL-17i with regard to infectious complications.

Among patients initiating IL-23 inhibitors compared with those initiating TNF inhibitors, treatment with IL-23 inhibitors was associated with a decreased risk for otitis media (hazard ratio [HR], 0.66; 95% CI, 0.44-0.97; P <.001), encephalitis (HR, 0.18; 95% CI, 0.04-0.78; P =.010), herpes zoster (HR, 0.58; 95% CI, 0.41-0.82; P =.002), hepatitis B virus (HBV) reactivation (HR, 0.24; 95% CI, 0.12-0.47; P <.001), cytomegalovirus (CMV; HR, 0.25; 95% CI, 0.07-0.86; P =.017), influenza (HR, 0.52; 95% CI, 0.38-0.71; P <.001), and parasitic diseases (HR, 0.78; 95% CI, 0.64-0.95; P =.011).

In a time-stratified analysis, patients who received IL-23 inhibitors also had a reduced risk for pneumonia, osteomyelitis, and Epstein-Barr virus (EBV) infection in the first year of treatment, and a lower risk for pneumonia and hepatitis C virus (HCV) reactivation 12 or more months after treatment initiation.

Among patients treated with IL-17 inhibitors compared with those who received TNF inhibitors, use of IL-17 inhibitors was associated with a reduced risk for pneumonia (HR, 0.76; 95% CI, 0.68-0.85; P <.001), septicemia (HR, 0.84; 95% CI, 0.72-0.97; P =.019), upper respiratory tract infection (HR, 0.84; 95% CI, 0.77-0.92; P <.001), herpes zoster (HR, 0.79; 95% CI, 0.67-0.92; P =.003), HBV (HR, 0.59; 95% CI, 0.46-0.76; P <.001) and HCV (HR, 0.71; 95% CI, 0.57-0.88; P =.002) reactivation, CMV (HR, 0.58; 95% CI, 0.36-0.93; P =.022), EBV (HR, 0.38; 95% CI, 0.19-0.75; P =.004), influenza (HR, 0.70; 95% CI, 0.61-0.81; P <.001), and parasitic diseases (HR, 0.80; 95% CI, 0.72-0.88; P <.001).

The risk for osteomyelitis was decreased in the first year following treatment, and the risk for cellulitis was decreased 12 months or longer after drug initiation, according to the time-stratified analysis.

Among several study limitations, patient electronic health record data may include inaccurate diagnoses and do not include all putative confounders. Also, there was a lack of detail regarding the clinical characteristics and severity of psoriasis and infectious outcomes.

“This study suggests a high safety profile of IL-23i and IL-17i with regard to infectious complications,” the researchers concluded. They added, “These agents might be considered positive in fragile patients with susceptibility to infections.”

This article originally appeared on Dermatology Advisor


Kridin K, Zirpel H, Mruwat N, Ludwig RJ, Thaci D. Evaluating the risk of infections under interleukin 23 and interleukin 17 inhibitors relative to tumour necrosis factor inhibitors—a population-based study. J Eur Acad Dermatol Venereol. Published online July 19, 2023. doi:10.1111/jdv.19328