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Candida Infections in Clinical Trials of Ixekizumab (Taltz), an Interleukin-17A Monoclonal Antibody, in Patients With Psoriasis or Psoriatic Arthritis

Bobonich, Margaret; Young, Melodie S.; Parker, Patti A.; Xu, Wen; Ridenour, Terri L.

Journal of the Dermatology Nurses’ Association: November/December 2019 - Volume 11 - Issue 6 - p 250–263
doi: 10.1097/JDN.0000000000000497
FEATURE ARTICLES
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ABSTRACT Interleukin-17 mediates immunity against pathogens such as Candida. Ixekizumab, an anti-interleukin-17A antibody, showed efficacy treating psoriasis (PsO) and psoriatic arthritis (PsA). Detailed here are Candida infections from 11 PsO and three PsA ixekizumab studies.

Overall, patients received 80-mg ixekizumab every 2 or 4 weeks for 12 weeks (PsO) or 24 weeks (PsA) and then every 4 weeks. Candida (high-level term), six Candida subcategories (oral, vulvovaginal, skin, esophageal, nail, and unspecific), and four fungal infections (esophagitis, oral, oropharyngitis, and vulvovaginal mycotic) were included. Patients were counted once per category for multiple events.

Analysis included 5,689 patients with PsO (12,061.5 patient-years of exposure, median exposure = 883 days) and 1,118 patients with PsA (1,373.4 patient-years of exposure, median exposure = 309 days). Overall, Candida infections were low and occurred in 4.4% (PsO incidence rate = 2.1) and 3.1% (PsA incidence rate = 2.5); most were mild or moderate in severity. The average duration of moderate and mild Candida ranged from 33 to 105 days. Most Candida infections were single events, 74% and 91%, with median onset of 328 and 146 days for PsO and PsA, respectively. Five patients (four with PsO and one with PsA) were reported to have a severe infection. Oral, skin, and vulvovaginal Candida were the most frequently reported Candida infections.

Margaret Bobonich, DNP, FNP-C, DCNP, FAANP, Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH.

Melodie S. Young, MSN, RN, A/GNP-C, BSW Modern Dermatology, Dallas, TX.

Patti A. Parker, PhD, RN, A/GNP-C, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX.

Wen Xu, PhD, Eli Lilly and Company, Indianapolis, IN.

Terri L. Ridenour, BSN, MBA, Eli Lilly and Company, Indianapolis, IN.

Funding was provided by Eli Lilly and Company.

M. Bobonich has been a speaker and advisory board member for Eli Lilly and Company and AbbVie and has been an advisory board member for Sun Pharma. M. S. Young has been a speaker for Novartis and Eli Lilly and Company and has been an advisory board member for Eli Lilly and Company and Ortho. P. A. Parker has no conflicts of interest to disclose. W. Xu and T. L. Ridenour are employees and stockholders of Eli Lilly and Company.

Correspondence concerning this article should be addressed to Margaret Bobonich, DNP, FNP-C, DCNP, FAANP, Department of Dermatology, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106. E-mail: margaret.bobonich@uhhospitals.org

Copyright © 2019 by the Dermatology Nurses' Association.