A Practical Guide to the Management of Oral Candidiasis in Patients with Plaque Psoriasis Receiving Treatments That Target Interleukin-17

Armstrong, April W.; Blauvelt, Andrew; Mrowietz, Ulrich; Strober, Bruce; Gisondi, Paolo; Merola, Joseph F.; Langley, Richard; Ståhle, Mona; Lebwohl, Mark; Netea, Mihai G.; Gomez, Natalie Nunez; Warren, Richard B.

doi:10.1007/s13555-022-00687-0

Cited by 10 publications

(8 citation statements)

References 67 publications

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“…Most often, oral candidiasis was treated with nystatin and/or fluconazole and the majority of infections were reported to resolve with treatment (median duration of 12 days) [ 22 ]. This is consistent with prior literature on treatment of oral candidiasis resulting from anti-IL-17 therapy for psoriasis [ 47 – 49 ]. In general, treatments for oral candidiasis are effective and have low resistance rates [ 50 ].…”

Section: Resultssupporting

confidence: 92%

“…Certain patient populations are at greater risk of developing candida infections. Predisposing risk factors include immunodeficiency (e.g., HIV, chemotherapy), antibiotics, older age, endocrine disorders, nutritional deficiencies, smoking, steroid inhalers, poor oral hygiene, and salivary hypofunction [ 49 ]. As such, candidal infections from bimekizumab can be effectively treated with current standard of care.…”

Section: Resultsmentioning

confidence: 99%

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The Efficacy and Safety of Bimekizumab for Plaque Psoriasis: An Expert Consensus Panel

Burshtein,

Shah,

Zakria

et al. 2024

Dermatol Ther (Heidelb)

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Introduction Psoriasis is a chronic inflammatory condition affecting the skin, joints, and several other organ systems with significant disease burden. Bimekizumab is the first monoclonal antibody targeting both interleukin (IL)-17A and interleukin-17F and has demonstrated efficacy for treating moderate to severe psoriasis. Limited guidelines exist for incorporating this drug into clinical practice. The purpose of this study was for a panel of experts in psoriasis management to synthesize current literature and provide consensus statements with guidance on use of bimekizumab. Methods A comprehensive literature search of PubMed, Scopus, and Google Scholar was completed for English-language original research articles on the use of bimekizumab for moderate to severe psoriasis and psoriatic arthritis. A panel of nine dermatologists with significant expertise in treatment of psoriasis gathered to review the articles and create consensus statements on this new medication. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned using Strength of Recommendation Taxonomy criteria. Results The literature search produced 102 articles that met criteria. A thorough screening of the studies for relevance to the research question resulted in 19 articles. These were distributed to all panelists for review prior to a roundtable discussion. The panel unanimously voted to adopt 14 consensus statements and recommendations, 12 of which were given a strength of “A”, one of which was given a strength of “B”, and one of which was given a strength of “C”. Conclusion Bimekizumab results in rapid and long-lasting clinical improvement for patients with moderate to severe plaque psoriasis and psoriatic arthritis. It has demonstrated superior efficacy when compared to several other biologics. The safety profile is consistent with other biologics, except for an increased incidence of oropharyngeal candidiasis.

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Section: Resultssupporting

confidence: 92%

Section: Resultsmentioning

confidence: 99%

The Efficacy and Safety of Bimekizumab for Plaque Psoriasis: An Expert Consensus Panel

Burshtein,

Shah,

Zakria

et al. 2024

Dermatol Ther (Heidelb)

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“…The dual inhibition of IL-17A and 17F by bimekizumab may contribute to its higher risk of infection. 40,41 This notion is also supported by previous reports that bimekizumab is associated with an increased incidence of oral candidiasis compared with other IL-17 inhibitors. 40,41 Several observational studies have analyzed the risk of serious infection related to targeted therapies in patients with psoriasis; however, these studies provided inconsistent results.…”

Section: Discussionsupporting

confidence: 74%

“…40,41 This notion is also supported by previous reports that bimekizumab is associated with an increased incidence of oral candidiasis compared with other IL-17 inhibitors. 40,41 Several observational studies have analyzed the risk of serious infection related to targeted therapies in patients with psoriasis; however, these studies provided inconsistent results. One large observational study conducted in the United States found that the risk of serious infection was slightly higher for biologic therapies compared with non-biologics (aHR, 1.31; 95% CI, 1.02-1.68).…”

Section: Discussionsupporting

confidence: 74%

Comparative short-term risks of infection and serious infection in patients receiving biologic and small-molecule therapies for psoriasis and psoriatic arthritis: a systemic review and network meta-analysis of randomized controlled trials

Chiu,

Hung,

Huang

2023

Therapeutic Advances in Chronic Disease

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Background: Infection events are a major concern for patients and physicians when making psoriasis treatment decisions. Objective: To estimate the relative short-term risks of infection and serious infection for biologic and small molecule therapies in the treatment of moderate-to-severe plaque psoriasis (PsO) and psoriatic arthritis (PsA). Data Sources and Methods: A systematic literature search of the PubMed, EMBASE, and Web of Science databases was conducted on 17 June 2022. We included phase II, III, or IV randomized controlled trials (RCTs) of biologic and small-molecule therapies that are licensed or likely to gain approval soon for PsO and PsA, as well as infection data reports. Two investigators independently extracted the data based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Network meta-analysis (NMA) was performed to estimate the pooled relative risks (RRs) and corresponding 95% confidence intervals of total infections and serious infections for treatments during placebo-controlled phases of RCTs. The surface under the cumulative ranking area (SUCRA) was calculated to rank the infection risk for each treatment. Results: A total of 94 RCTs with a total of 19 treatment arms involving 54,369 participants were analyzed. For patients with PsO, bimekizumab, secukizumab, risankizumab, ustekinumab, apremilast, guselkumab, and adalimumab were associated with significantly higher risks of infection than placebo; SUCRA ranked infliximab, deucravacitinib, and bimekizumab with the highest risks of infection. For patients with PsA, bimekizumab, apremilast, and upadacitinib (30 mg daily) were associated with higher risks of infection; SUCRA ranked bimekizumab with the highest risk of infection. No treatments, except for upadacitinib (30 mg daily), were associated with a higher risk of serious infection than placebo in PsA. Conclusion: This NMA provides a comprehensive assessment of the comparative short-term risks of infection, which could help physicians and patients to select individualized treatments for psoriasis. Registration: CRD42022359873.

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“…Another possible explanation is that, as brodalumab inhibits IL-17 R, it prevents the activity of all other IL-17 cytokines, even IL-17E, which may indirectly inhibit Th17 responses (Iwakura et al 2011 ). In addition, if IL-17 R is not entirely prevented after the dosing cycle, residual IL-17 May likely confer defence against Candida (Armstrong et al 2022 ). However, further studies are required on this topic for better understanding.…”

Section: Comparison Of the Risk Of Candidiasis Between Different Il-1...mentioning

confidence: 99%

Risk of candidiasis associated with interleukin-17 inhibitors: Implications and management

Bilal,

Khan,

Khan

et al. 2023

Mycology

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The application of interleukin-17 (IL-17) inhibitors, including secukinumab, ixekizumab, brodalumab, and bimekizumab, are associated with elevated risk of candidiasis. These medications interfere with the IL-17 pathway, which is essential for maintaining mucosal barriers and coordinating the immune response against Candida species. The observational data and clinical trials demonstrate the increased incidence of candidiasis in individuals treated with IL-17 inhibitors. Brodalumab and bimekizumab pose a greater risk than secukinumab in eliciting candidiasis, whereas the data regarding ixekizumab are equivocal. Higher doses and prolonged treatment duration of IL-17 inhibitors increase the risk of candidiasis by compromising the immune response against Candida species. Prior to prescribing IL-17 inhibitors, healthcare professionals should comprehensively evaluate patients’ medical histories and assess their risk factors. Patients should be educated on the signs and symptoms of candidiasis to facilitate early detection and intervention. Future research should focus on identifying the risk factors associated with candidiasis in patients receiving IL-17 inhibitors. Prospective studies and long-term surveillance are required to explore the impact of specific inhibitors on the incidence and severity of candidiasis and to evaluate the effectiveness of combination therapies, such as concurrent use of IL-17 inhibitors and prophylactic antifungal agents.

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A Practical Guide to the Management of Oral Candidiasis in Patients with Plaque Psoriasis Receiving Treatments That Target Interleukin-17

Cited by 10 publications

References 67 publications

The Efficacy and Safety of Bimekizumab for Plaque Psoriasis: An Expert Consensus Panel

The Efficacy and Safety of Bimekizumab for Plaque Psoriasis: An Expert Consensus Panel

Comparative short-term risks of infection and serious infection in patients receiving biologic and small-molecule therapies for psoriasis and psoriatic arthritis: a systemic review and network meta-analysis of randomized controlled trials

Risk of candidiasis associated with interleukin-17 inhibitors: Implications and management

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