Table 2.
Factors associated with invasive fungal infection (IFI) development in patients within one year after initiating IL-17 or IL-23 inhibitors, United States, July 2016‒January 31, 2022*
| Characteristic | IL-17 inhibitor | IL-23 inhibitor | ||||
|---|---|---|---|---|---|---|
| IFI (n=67) | No IFI (n=13,767) | P-value | IFI (n=58) | No IFI (n=19,644) | P-value | |
| Age group (years) | 0.054 | 0.447 | ||||
| 0–17 | 0 (0) | 88 (1) | 1 (2) | 605 (3) | ||
| 18–44 | 13 (19) | 4690 (34) | 23 (40) | 8742 (45) | ||
| 45–64 | 48 (72) | 8227 (60) | 29 (50) | 9383 (48) | ||
| ≥65 | 6 (9) | 762 (6) | 5 (9) | 914 (5) | ||
| Female | 41 (61) | 7333 (53) | 0.194 | 27 (47) | 10082 (51) | 0.468 |
| U.S. census region † | 0.806 | 0.003 | ||||
| Northeast | 9 (14) | 2245 (16) | 0.525 | 4 (7) | 3674 (19) | 0.021 |
| South | 36 (55) | 6690 (49) | 0.401 | 29 (50) | 9463 (48) | 0.781 |
| Midwest | 12 (18) | 2844 (21) | 0.579 | 10 (17) | 4097 (21) | 0.499 |
| West | 9 (14) | 1968 (14) | 0.841 | 15 (26) | 2356 (12) | 0.001 |
| Indications for IL-17 or IL-23 inhibitor | ||||||
| Psoriasis | 49 (73) | 10236 (74) | 0.820 | 24 (41) | 11909 (61) | 0.003 |
| Psoriatic arthritis | 22 (33) | 4493 (33) | 0.972 | 11 (19) | 1707 (9) | 0.006 |
| Ankylosing spondylitis | 8 (12) | 1493 (11) | 0.774 | 1 (2) | 117 (1) | 0.295 |
| Inflammatory bowel disease | 0 (0) | 85 (1) | >0.999 | 33 (57) | 6033 (31) | <.0001 |
| Crohn's disease | 0 (0) | 39 (0) | >0.999 | 31 (53) | 5147 (26) | <.0001 |
| Ulcerative colitis | 0 (0) | 48 (0) | >0.999 | 6 (10) | 1821 (9) | 0.780 |
| Behçeťs disease | 0 (0) | 8 (0) | >0.999 | 0 (0) | 9 (0) | >0.999 |
| Pyoderma gangrenosum | 0 (0) | 7 (0) | >0.999 | 1 (2) | 54 (0) | 0.150 |
| Hydradenitis suppuritiva | 1 (1) | 93 (1) | 0.367 | 1 (2) | 187 (1) | 0.427 |
| Lichen planus | 0 (0) | 22 (0) | >0.999 | 0 (0) | 34 (0) | >0.999 |
| Seborrheic dermatitis | 0 (0) | 246 (2) | 0.635 | 1 (2) | 473 (2) | >0.999 |
| Juvenile arthritis | 0 (0) | 51 (0) | >0.999 | 0 (0) | 40 (0) | >0.999 |
| Rheumatoid arthritis | 10 (15) | 1412 (10) | 0.209 | 1 (2) | 601 (3) | >0.999 |
| Other underlying conditions (present during the 180 days before starting IL-17 or IL-23 inhibitor) | ||||||
| Diabetes mellitus | 14 (21) | 1964 (14) | 0.122 | 5 (9) | 2059 (10) | 0.644 |
| Hematologic malignancy | 0 (0) | 60 (0) | >0.999 | 1 (2) | 57 (0) | 0.157 |
| Solid malignancy | 3 (4) | 289 (2) | 0.167 | 1 (2) | 354 (2) | >0.999 |
| Neutropenia | 0 (0) | 20 (0) | >0.999 | 0 (0) | 27 (0) | >0.999 |
| Stem cell transplant | 0 (0) | 1 (0) | >0.999 | 1 (2) | 5 (0) | 0.018 |
| Solid organ transplant | 0 (0) | 10 (0) | >0.999 | 1 (2) | 29 (0) | 0.085 |
| HIV infection | 0 (0) | 17 (0) | >0.999 | 0 (0) | 43 (0) | >0.999 |
| Concurrent immunosuppressive medications (prescription filled at least once during period during which the patient started the IL17 or IL23 inhibitor to 365 days later or to development of IFI, whichever occurred earlier) | ||||||
| Corticosteroids | 15 (22) | 1577 (11) | 0.005 | 21 (36) | 2245 (11) | <0.001 |
| Tacrolimus | 0 (0) | 278 (2) | 0.647 | 1 (2) | 334 (2) | >0.999 |
| Cyclosporine | 1 (1) | 229 (2) | >0.999 | 0 (0) | 203 (1) | >0.999 |
| Methotrexate | 11 (16) | 1696 (12) | 0.309 | 7 (12) | 1233 (6) | 0.094 |
| Mycophenolate mofetil | 0 (0) | 46 (0) | >0.999 | 1 (2) | 47 (0) | 0.132 |
| Small molecule kinase inhibitors | 3 (4) | 298 (2) | 0.179 | 0 (0) | 211 (1) | >0.999 |
| Antifungal prophylaxis (≥21 days’ supply during the 90 days before starting IL-17 or IL-23 inhibitor) | ||||||
| Pneumocystis prophylaxis | 0 (0) | 46 (0) | >0.999 | 1 (2) | 107 (1) | 0.273 |
| Voriconazole, posaconazole, or isavuconazole | 0 (0) | 2 (0) | >0.999 | 0 (0) | 4 (0) | >0.999 |
| Fluconazole | 0 (0) | 56 (0) | >0.999 | 0 (0) | 85 (0) | >0.999 |
IFIs and underlying conditions were identified using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. A full list of ICD-10-CM codes used is available as a supplemental table. Patients could have more than one underlying condition. P values were calculated using chi-square or Fisher’s exact tests (for small cell sizes) for proportions.
U.S. census region of primary beneficiary’s residence. Map of U.S. census regions: https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf. U.S. census region was unknown or missing for 21 patients on IL-17 inhibitors and 54 patients on IL-23 inhibitors.