IL-17 Inhibitor Safety in Psoriasis: Candidiasis, IBD, and Mental Health

This episode, "IL-17 Inhibitor Safety in Psoriasis: Candidiasis, IBD, and Mental Health," features the panel putting the class's safety signals in context.

Dr. Wright says candidiasis does not trouble her. She reminds viewers that all rheumatologists trained as internists and can offer a pill, a swish-and-swallow, or a lozenge. The data confirm it is not systemic fungemia, unlike the mycobacterial or endemic fungal reactivations she genuinely worries about. She pre-counsels patients on what thrush looks like and gives them three treatment options, which removes fear from the decision.

Dr. Han agrees, saying the worst thing he has to warn about is a fairly harmless side effect. Patients sometimes react with disbelief that the news is so mild. Dr. Wright compares it to counseling asthma patients on rinsing after a steroid inhaler, a familiar conversation clinicians already know how to have.

Dr. Han then turns to a slightly higher signal for fungal infections with IL-17s generally, including tinea corporis, tying it to the cytokine's role in host defense. He notes psoriasis lesions are almost never infected. On inflammatory bowel disease, he recounts the surprising secukinumab result showing worsened Crohn's disease. He is emphatic that an IL-17 inhibitor will not give someone IBD, but may unmask a predisposition. He adds animal data suggesting IL-17A and IL-17F play differing roles, with F blockade tending to ameliorate colitis.

Dr. Wright addresses suicidal ideation, noting brodalumab, a receptor blocker, is not approved for psoriatic arthritis. She frames mental wellness as integral to rheumatic care, since psoriatic disease itself raises depression and anxiety risk. She discusses self-harm carefully, ensures struggling patients get appropriate resources, and warns against attributing the concern to one drug alone.

In "Real-World Evidence and Systemic Inflammation in Psoriasis," the panel weighs the retrospective database claims that IL-23 inhibitors may slow progression to psoriatic arthritis, and how much stock to put in them.