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

Khalaf Kridin*, Henner Zirpel, Noor Mruwat, Ralf J. Ludwig, Diamant Thaci

*Corresponding author for this work
2 Citations (Scopus)


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.

Original languageEnglish
JournalJournal of the European Academy of Dermatology and Venereology
Issue number11
Pages (from-to)2319-2326
Number of pages8
Publication statusPublished - 11.2023

Research Areas and Centers

  • Academic Focus: Center for Infection and Inflammation Research (ZIEL)
  • Centers: Center for Research on Inflammation of the Skin (CRIS)

DFG Research Classification Scheme

  • 204-05 Immunology
  • 205-22 Clinical Immunology and Allergology
  • 205-14 Haematology, Oncology

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