IL-17 and IL-23 Inhibitor Infection Risk Low in PsA, PsO

The short-term risk and long-term incidence of infections and malignancies among patients with psoriasis (PsO) and psoriatic arthritis (PsA) receiving IL-17 inhibitors and IL-23 inhibitors are generally low, a recent comprehensive meta-analysis published in Frontiers in Immunology revealed.

“To date, IL-17 inhibitors and IL-23 inhibitors have been proven generally safe and well-tolerated,” the team said. “However, individual trials lack large sample sizes or long-term trial durations to detect the risk of rare adverse events such as serious infections and malignancies.”

The investigators pulled data from 45 randomized placebo-controlled studies and 27 open-label extension studies until May 2023, from PubMed, MEDLINE, Web of Science and clinicaltrials.gov. The primary endpoints were estimates of short-term risk ratios (RRs), and long-term exposure-adjusted incidence rates (EAIRs).

For patients taking IL-17 inhibitors, short-term risks of serious infection were 1.45 (95% CI 0.81-2.59), overall infection risks were 1.20 (95% CI 1.06-1.35), and malignancy risks were 0.83 (95% CI 0.41-1.71). There was, however, an increased short-term risk of nasopharyngitis and Candida infection in this patient group.

For patients taking IL-23 inhibitors, short-term risks were 0.68 (95% CI 0.38-1.22) for serious infection, 1.13 (95% CI 1.00-1.28) for overall infection, and 0.87 (95% CI 0.37-2.04) for malignancy.

Candida infection appeared to be a prominent adverse event for IL-17 inhibitors. The findings suggested that the short-term risk of Candida infection was approximately “3-fold higher with IL-17 inhibitors compared with placebo.”

No active or reactivated tuberculosis was reported, and only a few cases of latent tuberculosis, hepatitis, and herpes zoster were reported during the long-term extension periods.

Reference:
Wu S, Xu Y, Yang L, Guo L and Jiang X. Short-term risk and long-term incidence rate of infection and malignancy with IL-17 and IL-23 inhibitors in adult patients with psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Front. Immunol. 2023;14. DOI:10.3389/fimmu.2023.1294416