Evaluating the risk of infections under interleukin 23 and interleukin 17 inhibitors relative to tumour necrosis factor inhibitors – A population-based study

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.