Predictive Factors of Eczematous Eruptions and Candidiasis during anti IL-17 Treatment in Psoriatic Patients: a Multicenter Italian Real-life Experience in Lazio Region
Giacomo Caldarola, Eleonora De Luca, Simone Amato, Alfredo Belcastro, Nicoletta Bernardini, Luca Bianchi, Annunziata Dattola, Clara De Simone, Gaia Moretta, Sabatino Pallotta, Ketty Peris, Antonio Richetta, Raimondo Rossi, Nevena Skroza, Marco GalluzzoAbstract
Background
Anti-interleukin (IL)-17 therapies have revolutionized psoriasis treatment, offering excellent clinical outcomes and safety profiles. However, these drugs have been associated with class-specific side effects, Candida infections and eczematous reactions.
Objective
To assess the frequency of Candida infections and cutaneous eczematous eruptions in patients with plaque psoriasis treated with secukinumab, ixekizumab, brodalumab, or bimekizumab and to identify risk factors.
Methods
A multicenter, retrospective, observational study was conducted involving patients with plaque psoriasis treated with anti-IL-17 biologics at five outpatient clinics in Lazio, Italy. Demographic, clinical data, treatment characteristics, and adverse events were analyzed. Cox regression models were used to identify factors associated with the occurrence of these adverse events.
Results
Among 1075 patients, 34 (3.2%) developed eczema, and 36 (3.3%) had candidiasis
Therapy was discontinued in 78.1% of eczema cases and 50% of candidiasis cases. Multivariate analysis showed that ixekizumab (HR 3.45, p = 0.050) and atopic history (HR 5.43, p = 0.023) were correlated with eczema, while bimekizumab (HR 23.30, p = 0.002) was strongly associated with candidiasis.
Conclusions
Anti-IL-17 therapies show varying risks of eczema and candidiasis. Personalized strategies, regular monitoring, and prophylactic measures are essential to improve outcomes.