Low incidence of invasive fungal infections in a large observational cohort of patients initiating IL-17 or IL-23 inhibitor therapy, United States, 2016-2022

To the Editor: Interleukin(IL)-17 and IL-23 inhibitors ∗ U.S. Food and Drug Administration (FDA)-approved IL-17 inhibitors are secukinumab, ixekizumab, and brodalumab; FDA-approved IL-23 inhibitors are ustekinumab, guselkumab, tildrakizumab, and risankizumab. are common treatments for psoriasis and other inflammatory disorders, 1 Lee M.P. Wu K.K. Lee E.B. Wu J.J. Risk for deep fungal infections during IL-17 and IL-23 inhibitor therapy for psoriasis. Cutis. 2020; 106: 199-205https://doi.org/10.12788/cutis.0088 Crossref Scopus (11) Google Scholar but may increase risk for invasive fungal infections (IFI), particularly candidiasis, as IL-17 and IL-23 are critical to innate antifungal immunity. 2 Sticherling M. Nikkels A.F. Hamza A.M. et al. Secukinumab in pediatric patients with plaque psoriasis: pooled safety analysis from two phase 3 randomized clinical trials. Am J Clin Dermatol. 2023; 24: 821-835https://doi.org/10.1007/s40257-023-00782-8 Crossref Scopus (5) Google Scholar , 3 Feng Y. Zhou B. Wang Z. et al. Risk of Candida infection and serious infections in patients with moderate-to-severe psoriasis receiving biologics: a systematic review and meta-analysis of randomized controlled trials. Int J Clin Pract. 2022; 20222442603https://doi.org/10.1155/2022/2442603 Crossref Scopus (5) Google Scholar , 4 Blauvelt A. Reich K. Papp K.A. et al. Safety of tildrakizumab for moderate-to-severe plaque psoriasis: pooled analysis of three randomized controlled trials. Br J Dermatol. 2018; 179: 615-622https://doi.org/10.1111/bjd.16724 Crossref PubMed Scopus (56) Google Scholar , 5 Saunte D.M. Mrowietz U. Puig L. Zachariae C. Candida infections in patients with psoriasis and psoriatic arthritis treated with interleukin-17 inhibitors and their practical management. Br J Dermatol. 2017; 177: 47-62https://doi.org/10.1111/bjd.15015 Crossref PubMed Scopus (218) Google Scholar Yet, most safety data come from clinical trials, which may not reflect real-world safety in broader populations. 2 Sticherling M. Nikkels A.F. Hamza A.M. et al. Secukinumab in pediatric patients with plaque psoriasis: pooled safety analysis from two phase 3 randomized clinical trials. Am J Clin Dermatol. 2023; 24: 821-835https://doi.org/10.1007/s40257-023-00782-8 Crossref Scopus (5) Google Scholar , 3 Feng Y. Zhou B. Wang Z. et al. Risk of Candida infection and serious infections in patients with moderate-to-severe psoriasis receiving biologics: a systematic review and meta-analysis of randomized controlled trials. Int J Clin Pract. 2022; 20222442603https://doi.org/10.1155/2022/2442603 Crossref Scopus (5) Google Scholar , 4 Blauvelt A. Reich K. Papp K.A. et al. Safety of tildrakizumab for moderate-to-severe plaque psoriasis: pooled analysis of three randomized controlled trials. Br J Dermatol. 2018; 179: 615-622https://doi.org/10.1111/bjd.16724 Crossref PubMed Scopus (56) Google Scholar We estimated IFI incidence and describe IFI risk factors in patients starting IL-17 and IL-23 inhibitors.