IL-17 inhibitors carried up to nearly five times the candidiasis risk of other psoriasis systemics

The edition in brief

In the British Association of Dermatologists biologics register, 18,635 adults with psoriasis contributed 118,018 person-years on systemic treatment. Tuberculosis (0.19 per 1000 person-years) and meningitis (0.25) were rare and mostly followed TNF-α inhibitors, especially adalimumab. IL-17 inhibitors were the only class with raised candidiasis risk, with incidence rate ratios from 2.67 versus apremilast to 4.65 versus ustekinumab; individual IL-17 agents did not differ. A three-round Delphi of 31 US experts placed oral JAK inhibitors as primary long-term therapy for severe alopecia areata in adults, with dupilumab as an alternative in comorbid atopy and minoxidil, corticosteroids and topical agents as supplements. In a phase 2 trial in China, a single intravenous dose of recibokibart, an IL-36 receptor antibody, achieved near-clear pustulation at day 8 in 86.4% of 22 patients with a generalised pustular psoriasis flare versus 9.1% of 11 on placebo. A retrospective validation of an integrated 40-gene expression profile in 572 high-risk cutaneous squamous cell carcinomas reported over 95% negative predictive value for its lowest class and identified 12.9% as highest risk, with an apparent benefit from adjuvant radiotherapy.