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Infection Risk Lower With IL-23i and IL-17i Than With TNFi in Psoriasis


Patients with psoriasis treated with IL-23i and IL-17i had a decreased risk of developing pneumonia, otitis media, and upper respiratory tract infections.

Researchers compared the use of interleukin (IL)-23 inhibitors (IL-23i) and IL-17i with the use of tumor necrosis factor inhibitors (TNFi) to manage psoriasis to evaluate the risk of infectious complications and found that IL-23i and IL-17i resulted in a lower risk of many infectious diseases.1



The global, population-based, retrospective, cohort study utilized the TriNetX database to follow patients with psoriasis treated with IL-23i, IL-17i, or TNFi. Kridin et al separated patients into 3 groups. The first group included patients treated with any IL-23i agents, including risankizumab, guselkumab, and tildrakizumab. The second group assessed patients treated with any IL-17i agents, including secukinumab, ixekizumab, and brodalumab. The third group included patients on TNFi treatments, including adalimumab, infliximab, etanercept, infliximab, and certolizumab pegol. To be included in a group, a patient must never have been prescribed treatment from 1 of the other groups.

All patients were longitudinally followed for risk of developing 26 different viral, bacterial, fungal, and opportunistic infections. IL-23i was compared to TNFi in 1 analysis, and IL-17i was compared to TNFi in another analysis. In the IL-23i analysis, 5272 patients with psoriasis who were treated with IL-23i were compared with 5272 patients treated with TNFi. In the IL-17i analysis, 15,160 patients treated with IL-17i were compared with a group of 15,160 patients treated with TNFi.

Those treated with IL-23i compared to TNFi showed a lower risk of developing otitis media, encephalitis, herpes zoster (HZ), hepatitis B virus (HBV) reactivation, cytomegalovirus (CMV), influenza, and parasitic diseases. Patients treated with IL-23i also showed a decreased risk of developing pneumonia, osteomyelitis, and Epstein-Barr virus (EBV) infection in the first year of treatment, and a lower risk of pneumonia and hepatitis C virus (HCV) reactivation 12 months of more after initiation of treatment.

When comparing risk of developing infections between patients treated with IL-17i compared to those treated with TNFi, patients with IL-17i treatment showed a lower risk of developing pneumonia, septicaemia, upper respiratory tract infection, HZ, HBV and HCV reactivation, CMV, EBV, influenza, and parasitic diseases. Patients treated with IL-17i had a lower risk of developing osteomyelitis in the first year following treatment initiation. The risk of cellulitis was lower 12 months or more following treatment initiation. The risk of reactivation of tuberculosis was comparable in both analyses.

“This study suggests a high safety profile of IL-23i and IL-17i with regard to infectious complications. These agents might be considered positive in fragile patients with susceptibility to infections,” concluded Kridin et al.


  1. Kridin K, Zirpel H, Mruwat N, Ludwig RJ, Thaci D. Evaluating the risk of infections under interleukin 23 and interleukin 17 inhibitors relative to tumour necrosis factor inhibitors – A population-based study. J Eur Acad Dermatol Venereol. 2023;00:1–8. https://doi.org/10.1111/jdv.19328
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