Predictive factors for eczematous eruptions and candidiasis during anti-interleukin-17 treatment in patients with psoriasis: a multicentre real-life experience in Lazio region, Italy

Background Anti-interleukin (IL)-17 treatments have revolutionized psoriasis treatment, offering excellent clinical outcomes and safety profiles. However, these drugs have been associated with class-specific side effects, including Candida infections and eczematous reactions.Objectives 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 multicentre, retrospective, observational study was conducted involving patients with plaque psoriasis treated with anti-IL-17 biologics at five outpatient clinics in Lazio, Italy. Demographic data, clinical data, treatment characteristics and adverse events were analysed. Cox regression models were used to identify factors associated with the occurrence of these adverse events.Results Of 1075 patients, 34 (3.2%) developed eczema, and 36 (3.3%) had candidiasis. Treatment was discontinued in 78% of patients who developed eczema and 50% of patients who had candidiasis. Multivariate analysis showed that ixekizumab [hazard ratio (HR) 3.45, P = 0.05] and atopic history (HR 5.43, P = 0.023) were significantly correlated with eczema, while bimekizumab (HR 23.30, P = 0.002) was significantly associated with candidiasis.Conclusions Anti-IL-17 treatments show varying risks of causing side effects such as eczema and candidiasis. Personalized strategies, regular monitoring and prophylactic measures are essential to improve patient outcomes.We investigated adverse events following anti-interleukin (IL)-17 treatment. Bimekizumab is associated with an increased risk of candidiasis, while ixekizumab is associated with an increased risk of eczema. Risk factors include atopic history, smoking and prior treatment with biologics. Our findings underscore the importance of personalized anti-IL-17 treatment strategies to optimize outcomes and effectively manage side effects.