A case of esophageal candidiasis in a psoriatic patient treated with ixekizumab: Should treatment be discontinued?

Abstract

Psoriasis is a chronic inflammatory skin disease with genetic background and autoimmune pathogenic traits. 1,2 Biotechnological therapy is a treatment option in moderate-to-severe psoriasis, with favorable benefit-risk balance and no cumulative organ-specific toxicity, which represented one of the most important major research advantages in the management of more severe and unresponsive forms of psoriasis. 3-5 However, biological treatments have been linked to an increased risk of infections. 4 Interleukin (IL)-17 is involved in mucocutaneous defense against extracellular pathogens including Candida

Guselkumab, Risankizumab, and Tildrakizumab in the Management of Psoriasis: A Review of the Real-World Evidence

“…Indeed, real-life data are mandatory to improve the dermatological decision-making process, because these studies also include patients who are typically excluded from clinical trials, such as subjects suffering from several comorbidities, subjects on polypharmacy, as well as multifailure patients. [15][16][17] Herein, we performed a comprehensive literature review about real-life data on guselkumab, risankizumab, and tildrakizumab.…”

Persistent candidiasis infection during anti‐IL‐17 treatment for plaque psoriasis requiring biologic discontinuation: a case series and literature review

“…We recorded the height and weight of the patients at the start and end of treatment and 2 years after treatment had ceased. The weight-for-age Z score (WAZ), height-for-age Z score (HAZ), and weight-for-height Z score (WHZ) calculated by WHO Anthro software 3 were used to assess physical development; these Z scores were calculated according to age and were thus more accurate.…”

“…2 Indeed, a genetic deficiency of IL-17A has been linked to persistent or recurrent Candida infection. 3 Therefore, patients treated with anti-IL-17A may have an increased risk of Candida mucocutaneous infection. 3 Herein, we report two cases of patients with psoriasis and PsA treated with secukinumab and ixekizumab, respectively, who developed oral candidiasis requiring treatment discontinuation.…”

“…4 Some evidence supports the essential role of IL-17 signaling in defending against Candida infections, 3 with a major role played by IL-17A and the receptor IL-17RA, highly expressed in the epithelial cells of the oral mucosa. 5 Saunte et al 5 systematically analyzed clinical trials to evaluate the incidence of candidiasis in patients receiving anti-IL-17A 3 Candida infections were reported in 4.0% of patients treated with brodalumab, 1.7% with secukinumab, and 3.3% with ixekizumab versus 0.3%, 2.3%, and 0.8% of those assigned to placebo, ustekinumab, or etanercept, respectively. 3 All cases were mild or moderate, self-healing or solved after topical therapy.…”

“…5 Saunte et al 5 systematically analyzed clinical trials to evaluate the incidence of candidiasis in patients receiving anti-IL-17A 3 Candida infections were reported in 4.0% of patients treated with brodalumab, 1.7% with secukinumab, and 3.3% with ixekizumab versus 0.3%, 2.3%, and 0.8% of those assigned to placebo, ustekinumab, or etanercept, respectively. 3 All cases were mild or moderate, self-healing or solved after topical therapy. Hence, the incidence of a Candida infection was only slightly increased.…”