PSORIASIS systemic treatments showed distinct infection risk profiles in a nationwide cohort of 18,635 patients, with tuberculosis and meningitis remaining rare and candidiasis occurring more frequently among patients receiving interleukin (IL)-17 inhibitors.
The study included 40,930 treatment episodes contributing 118,018 person-years of follow-up between 2007 and 2024. Adults with psoriasis receiving systemic treatments were followed from treatment initiation until treatment discontinuation, death, or the last available follow-up.
The researchers assessed tuberculosis, meningitis, candidiasis, and other fungal infections, calculating incidence rates and incidence rate ratios (IRRs) using adjusted statistical models.
During follow-up, 22 cases of tuberculosis, 29 cases of meningitis, and 888 fungal infections were reported, including 450 cases of candidiasis. Overall incidence rates per 1000 person-years were 0.19 for tuberculosis (95% confidence interval [CI]: 0.12–0.29), 0.25 for meningitis (95% CI: 0.16–0.35), and 7.53 for fungal infections (95% CI: 7.05–8.05).
Most tuberculosis and meningitis cases were associated with tumour necrosis factor alpha (TNF-α) inhibitors, particularly adalimumab. Tuberculosis was largely pulmonary, while meningitis was predominantly viral. Fewer than five meningitis cases were associated with mortality within 30 days.
IL-17 inhibitors were associated with an increased risk of candidiasis compared with all other systemic treatment groups. IRRs ranged from 2.67 versus apremilast (95% CI: 1.33–5.36) to 4.65 versus IL-12/23 inhibitors (95% CI: 3.46–6.24).
Individual IL-17 inhibitors did not show significant differences in candidiasis risk, while no statistically significant differences between treatment groups were observed for fungal infections other than candidiasis.
The researchers concluded that tuberculosis and meningitis were rare among patients receiving systemic psoriasis treatments, although longer-term follow-up was needed to further characterise risks associated with newer treatments.
In contrast, candidiasis and fungal infections were more common, with increased candidiasis risk observed among patients receiving IL-17 inhibitors. The findings highlight differing infection profiles across systemic treatment groups, particularly with regard to candidiasis.
Reference
Bright H B B et al. Risks of tuberculosis, meningitis, candidiasis, and fungal infections among patients receiving systemic treatments for psoriasis: a nationwide cohort study from BADBIR data, British Journal of Dermatology, 2026;, ljag397, https://doi.org/10.1093/bjd/ljag397
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