Risk of fungal infection in patients with psoriasis receiving biologics: A retrospective single-center cohort study

J Am Acad Dermatol. 2025 Jan;92(1):108-115. doi: 10.1016/j.jaad.2024.09.037. Epub 2024 Sep 30.

Abstract

Background: The risk of fungal infection in patients with psoriasis receiving biologics is not fully understood in clinical practice.

Objective: To assess the incidence and the risk of fungal infection onset in patients with psoriasis receiving biologics.

Methods: A retrospective cohort study of 592 psoriasis cases treated with biologics at a single center.

Results: Seventy-three (12.3%) of the 592 cases involved a fungal infection. Fungal infection occurrence was more frequently associated with the use of interleukin (IL) 17 inhibitors than of other biologics. The risk factors of fungal infection were the type of biologic agent (P = .004), age at the start of biologic therapy (odds ratio, 1.04; 95% CI, 1.02-1.06), and diabetes mellitus (odds ratio, 2.40; 95% CI, 1.20-4.79).

Limitations: The present, retrospective study did not include patients who did not receive biologic therapy. Moreover, the type of biologic agent used was changed in many cases.

Conclusions: Patients with psoriasis treated with IL-17 inhibitors were more likely to cause fungal infections, especially candidiasis, than other biologics. Moreover, the age at the start of biologic therapy and diabetes mellitus onset were also independent risk factors of fungal infection.

Keywords: age; biologics; candidiasis; diabetes mellitus; fungal infection; interleukin 17 inhibitor.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Biological Products* / adverse effects
  • Biological Products* / therapeutic use
  • Candidiasis / chemically induced
  • Candidiasis / epidemiology
  • Cohort Studies
  • Diabetes Mellitus / epidemiology
  • Female
  • Humans
  • Incidence
  • Infliximab / adverse effects
  • Infliximab / therapeutic use
  • Interleukin-17 / antagonists & inhibitors
  • Male
  • Middle Aged
  • Mycoses / chemically induced
  • Mycoses / epidemiology
  • Psoriasis* / complications
  • Psoriasis* / drug therapy
  • Psoriasis* / epidemiology
  • Retrospective Studies
  • Risk Factors

Substances

  • Biological Products
  • Interleukin-17
  • Infliximab