Risk of Candida Infection and Serious Infections in Patients with Moderate-to-Severe Psoriasis Receiving Biologics: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Background. Biological agents used to treat moderate-to-severe plaque psoriasis have been associated with Candida infection and other serious infections. It is, however, necessary to verify whether biologic agents increase the risk of Candida infection and serious infections and whether these risks...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | International Journal of Clinical Practice |
| Online Access: | http://dx.doi.org/10.1155/2022/2442603 |
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| author | Yue Feng Baosen Zhou Zhen Wang Guijuan Xu Lili Wang Tingting Zhang Yanping Zhang |
| author_facet | Yue Feng Baosen Zhou Zhen Wang Guijuan Xu Lili Wang Tingting Zhang Yanping Zhang |
| author_sort | Yue Feng |
| collection | DOAJ |
| description | Background. Biological agents used to treat moderate-to-severe plaque psoriasis have been associated with Candida infection and other serious infections. It is, however, necessary to verify whether biologic agents increase the risk of Candida infection and serious infections and whether these risks vary among biologics. Methods. PubMed, EMBASE, and Cochrane Library were searched for eligible randomized controlled trials (RCTs) from their inception to December 2021. Results from individual RCT were pooled using Peto’s method with a fixed-effects model, and I2 was calculated to assess the heterogeneity. A Cochrane collaboration tool was used to examine bias risk, and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) were used to assess the quality of evidence. Results. This study included 48 published articles with data from 52 RCTs involving 27297 participants. The anti-interleukin (IL)-17 agents (95% confidence interval (CI) = 1.54–3.45, P<0.0001) and anti-IL-12/23 agents (95% CI = 1.69–3.83, P<0.0001) were associated with an increased risk of Candida infection compared with placebos, but there was no difference in Candida infection risk between anti-IL-17 agents and tumor necrosis factor inhibitors (TNFi) (95% CI = 0.92–3.07, P=0.09). There was no evidence that the biological agents increased the risk of serious infections in adult psoriasis (95% CI = 0.93–2.06, P=0.11) or that the biologics differed in the risk of serious infections. Conclusions. Our results indicated that anti-IL-17 agents, especially secukinumab, were associated with the increased risk of Candida infection. The clinically used biological agents did not increase the risk of serious infections. |
| format | Article |
| id | doaj-art-1ac98224be234e0aa6e365ed7b069467 |
| institution | Kabale University |
| issn | 1742-1241 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Clinical Practice |
| spelling | doaj-art-1ac98224be234e0aa6e365ed7b0694672025-02-03T06:08:45ZengWileyInternational Journal of Clinical Practice1742-12412022-01-01202210.1155/2022/2442603Risk of Candida Infection and Serious Infections in Patients with Moderate-to-Severe Psoriasis Receiving Biologics: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsYue Feng0Baosen Zhou1Zhen Wang2Guijuan Xu3Lili Wang4Tingting Zhang5Yanping Zhang6Department of DermatologyDepartment of EpidemiologyDepartment of DermatologyDepartment of DermatologyDepartment of DermatologyDepartment of DermatologyDepartment of DermatologyBackground. Biological agents used to treat moderate-to-severe plaque psoriasis have been associated with Candida infection and other serious infections. It is, however, necessary to verify whether biologic agents increase the risk of Candida infection and serious infections and whether these risks vary among biologics. Methods. PubMed, EMBASE, and Cochrane Library were searched for eligible randomized controlled trials (RCTs) from their inception to December 2021. Results from individual RCT were pooled using Peto’s method with a fixed-effects model, and I2 was calculated to assess the heterogeneity. A Cochrane collaboration tool was used to examine bias risk, and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) were used to assess the quality of evidence. Results. This study included 48 published articles with data from 52 RCTs involving 27297 participants. The anti-interleukin (IL)-17 agents (95% confidence interval (CI) = 1.54–3.45, P<0.0001) and anti-IL-12/23 agents (95% CI = 1.69–3.83, P<0.0001) were associated with an increased risk of Candida infection compared with placebos, but there was no difference in Candida infection risk between anti-IL-17 agents and tumor necrosis factor inhibitors (TNFi) (95% CI = 0.92–3.07, P=0.09). There was no evidence that the biological agents increased the risk of serious infections in adult psoriasis (95% CI = 0.93–2.06, P=0.11) or that the biologics differed in the risk of serious infections. Conclusions. Our results indicated that anti-IL-17 agents, especially secukinumab, were associated with the increased risk of Candida infection. The clinically used biological agents did not increase the risk of serious infections.http://dx.doi.org/10.1155/2022/2442603 |
| spellingShingle | Yue Feng Baosen Zhou Zhen Wang Guijuan Xu Lili Wang Tingting Zhang Yanping Zhang Risk of Candida Infection and Serious Infections in Patients with Moderate-to-Severe Psoriasis Receiving Biologics: A Systematic Review and Meta-Analysis of Randomized Controlled Trials International Journal of Clinical Practice |
| title | Risk of Candida Infection and Serious Infections in Patients with Moderate-to-Severe Psoriasis Receiving Biologics: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_full | Risk of Candida Infection and Serious Infections in Patients with Moderate-to-Severe Psoriasis Receiving Biologics: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_fullStr | Risk of Candida Infection and Serious Infections in Patients with Moderate-to-Severe Psoriasis Receiving Biologics: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_full_unstemmed | Risk of Candida Infection and Serious Infections in Patients with Moderate-to-Severe Psoriasis Receiving Biologics: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_short | Risk of Candida Infection and Serious Infections in Patients with Moderate-to-Severe Psoriasis Receiving Biologics: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_sort | risk of candida infection and serious infections in patients with moderate to severe psoriasis receiving biologics a systematic review and meta analysis of randomized controlled trials |
| url | http://dx.doi.org/10.1155/2022/2442603 |
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