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Review
. 2023 Oct 20;15(1):30-44.
doi: 10.1080/21501203.2023.2265664. eCollection 2024.

Risk of candidiasis associated with interleukin-17 inhibitors: Implications and management

Hazrat Bilal  1 , Muhammad Nadeem Khan  2 , Sabir Khan  1 , Wenjie Fang  3 , Wenqiang Chang  4 , Bin Yin  5 , Ning-Jing Song  6 , Zhongrong Liu  7 , Dongxing Zhang  8   9 , Fen Yao  10 , Xun Wang  1 , Qian Wang  1 , Lin Cai  1 , Bing Hou  11 , Jiayue Wang  12 , Chunyan Mao  12 , Lingxi Liu  12 , Yuebin Zeng  12
Affiliations
Review

Risk of candidiasis associated with interleukin-17 inhibitors: Implications and management

Hazrat Bilal et al. Mycology. .

Abstract

The application of interleukin-17 (IL-17) inhibitors, including secukinumab, ixekizumab, brodalumab, and bimekizumab, are associated with elevated risk of candidiasis. These medications interfere with the IL-17 pathway, which is essential for maintaining mucosal barriers and coordinating the immune response against Candida species. The observational data and clinical trials demonstrate the increased incidence of candidiasis in individuals treated with IL-17 inhibitors. Brodalumab and bimekizumab pose a greater risk than secukinumab in eliciting candidiasis, whereas the data regarding ixekizumab are equivocal. Higher doses and prolonged treatment duration of IL-17 inhibitors increase the risk of candidiasis by compromising the immune response against Candida species. Prior to prescribing IL-17 inhibitors, healthcare professionals should comprehensively evaluate patients' medical histories and assess their risk factors. Patients should be educated on the signs and symptoms of candidiasis to facilitate early detection and intervention. Future research should focus on identifying the risk factors associated with candidiasis in patients receiving IL-17 inhibitors. Prospective studies and long-term surveillance are required to explore the impact of specific inhibitors on the incidence and severity of candidiasis and to evaluate the effectiveness of combination therapies, such as concurrent use of IL-17 inhibitors and prophylactic antifungal agents.

Keywords: Candidiasis; IL-17 inhibitors; bimekizumab; brodalumab; ixekizumab; secukinumab.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Model of oral candidiasis and the immune system’s response for clearing Candida species. In response to Candida species, macrophages are activated, which recruit CD4+T cells or TH17 cells through various cytokines, in order to activate neutrophils or release β-defensin to clear Candida infection.
Figure 2.
Figure 2.
IL-17 inhibitors, attachment sites, and mechanism of action. Secukinumab and ixekizumab interact with IL-17A/A, and A/F, bimekizumab attached to IL-17A/A, A/F, and F/F, and brodalumab inhibit IL-17A, IL-17C, and IL-17E.
Figure 3.
Figure 3.
Monitoring of candidiasis in patients treated with IL-17 inhibitors.
Figure 4.
Figure 4.
Clinical presentation, diagnosis and treatment of candidiasis associated with IL-17 inhibitors.
See this image and copyright information in PMC

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