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. 2023 Nov;37(11):2319-2326. doi: 10.1111/jdv.19328. Epub 2023 Jul 19.

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.

MeSH terms

  • Antirheumatic Agents* / therapeutic use
  • Cohort Studies
  • Epstein-Barr Virus Infections*
  • Herpesvirus 4, Human
  • Humans
  • Influenza, Human* / chemically induced
  • Influenza, Human* / drug therapy
  • Interleukin Inhibitors
  • Interleukin-17
  • Interleukin-23
  • Parasitic Diseases* / chemically induced
  • Parasitic Diseases* / drug therapy
  • Psoriasis* / chemically induced
  • Psoriasis* / complications
  • Psoriasis* / drug therapy
  • Tumor Necrosis Factor Inhibitors / therapeutic use

Substances

  • Tumor Necrosis Factor Inhibitors
  • Interleukin-17
  • Interleukin-23
  • Interleukin Inhibitors
  • Antirheumatic Agents