P162 Risks of tuberculosis, meningitis, candidiasis and fungal infections among patients receiving systemic treatments for psoriasis

Abstract

Systemic treatments for psoriasis may have differential risks of tuberculosis, meningitis, candidiasis and other fungal infections. This study was designed to evaluate real-world comparative data across systemic treatments, including newer biologics such as interleukin (IL)-17 and IL-23 inhibitors. We conducted a cohort study using British Association of Dermatologists Biologics and Immunomodulators Register data from 2007 to 2024. Adults with psoriasis receiving systemic treatments were included and followed from treatment initiation until treatment discontinuation, death or last available follow-up data. Primary outcomes included tuberculosis, meningitis, candidiasis and other fungal infections. Incidence rates per 1000 person-years were calculated and incidence rate ratios (IRRs) were estimated using a doubly robust interval-based Poisson regression model. Covariate balance was achieved using entropy balancing, and missing data were handled using multiple imputation. Overall, 40 930 treatment episodes from 18 635 patients contributing 118 018 person-years of follow-up were included in this analysis. Twenty-two cases of tuberculosis, 29 cases of meningitis and 888 cases of fungal infection, including 450 of candidiasis, were reported. The overall incidence rates per 1000 person-years were 0.19 [95% confidence interval (CI) 0.12–0.29] for tuberculosis, 0.25 (95% CI 0.16–0.35) for meningitis and 7.53 (95% CI 7.05–8.05) for fungal infections. Most cases of tuberculosis and meningitis were associated with tumour necrosis factor-α inhibitors. Meningitis was predominantly viral and tuberculosis was largely pulmonary. IL-17 inhibitors exhibited increased risk of candidiasis compared with other treatment groups, with IRRs ranging from 2.67 (95% CI 1.33–5.36) vs. apremilast to 4.65 (95% CI 3.46–6.24) vs. ustekinumab. With fungal infections other than candidiasis, no statistically significant differences were observed between treatment groups. No cases of tuberculosis or meningitis occurred among those receiving IL-23 inhibitors, and the risk of fungal infection was numerically lower. The incidences of tuberculosis and meningitis were rare, whereas candidiasis and fungal infections were more common with increased risks among those using IL-17 inhibitors. IL-23 inhibitors consistently showed lower risks across all analyses.