Ankylosing spondylitis medication may increase risk of fungal infections: Study

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Rajeev Choudhury

In a study published recently in the journal, The Lancet Regional Health, the researchers have found that Interleukin-17 (IL-17) inhibitors, used to control ankylosing spondylitis may increase the risk of contracting fungal infection caused by Candida species among patients.

Candidiasis is a fungal infection caused by candida species and generally infects skin, tongue and oesophagus or the food pipe in humans.

Analysing data from the World Health organisation (WHO), the European Medicines Agency (EMA), a population-based prescriptions registry, and a psoriasis cohort, the researchers from the Netherlands and Germany found that those treated with IL-17 inhibitors remain at higher risk of contracting candida infection, which increases their burden of disease.

The probability of developing candidiasis among the patients receiving IL-17 inhibitor treatment was 4-10 (WHO data),  16-33 times (EMA data), 2-42 times (prescription registry data)  and 3-25 times (psoriasis cohort data), as compared to those who were treated with TNF-α blockers they noted in the paper.

Both IL-17 inhibitors and TNF-α blockers are used to treat patients of ankylosing spondylitis when the conventional treatments fail to provide relief.

Individual Case Safety Report (ICSR) from WHO was accessed by the researchers and they found that for a patient who was put on IL-17 inhibitor medication the probability of reporting candidiasis was 10.20 compared to the patients who were put on anti-TNFα medications the probability of contracting candidiasis was 2.03.

The average time taken for onset of candidiasis infection was 84 days in the case of patients on IL-17 inhibitors while it was 204 days for patients on anti-TNFα medication.

In the EMA data, the researchers looked into exposure adjusted event rates and their analysis revealed that among the patients who were on IL-17 inhibitor medication the event rate was 0.35 compared to 0.20 for the patients who were on anti-TNFα medication.

Compared to anti-TNFα, the candidiasis event rate for anti-IL17 was higher at 1·99, the researchers pointed out.

Data from the psoriasis cohort study revealed that among the patients who were on IL-17 inhibitor medication 58% of the patients developed candidiasis, compared to 15.13% among patients on anti-TNFα medication.

“This suggests that close monitoring of IL-17 inhibitor recipients for candidiasis is advisable, and antifungal prophylaxis may be considered for patients with recurrent or chronic candidiasis. Future studies may identify additional predisposing host factors amenable for screening of anti-IL-17 candidates, to guide antifungal prophylaxis or anti-Candida vaccination (currently in phase 2 studies) in the future,” they noted.

“IL-17 inhibitors are associated with an increased risk of oropharyngeal, oesophagal, and cutaneous candidiasis, posing a significant disease burden for IL-17 inhibitor recipients,” the researchers of the study concluded.


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