Risk of cancer, tuberculosis and serious infections in patients with ankylosing spondylitis, psoriatic arthritis, and psoriasis treated with IL-17 and TNF-α; inhibitors: a nationwide nested case-control analysis

Objective Targeting interleukin (IL)-17 and tumour necrosis factor (TNF)-alpha is recommended for the management of severe/ refractory ankylosing spondylitis (AS), psoriatic arthritis (PsA) and psoriasis (PsO); however, safety data comparing these agents, especially in a large Asian population are unavailable. Methods Patients with AS, PsA and PsO were searched using the Health Insurance Review and Assessment Service database, defined according to the International Classification of Diseases-10 and unique insurance codes for rare diseases. By including patients newly diagnosed with AS, PsA, and PsO between 2010-2020, the outcomes of cancer, tuberculosis (TB), and serious infections following IL-17 and TNF-alpha inhibitor usage were evaluated. To investigate the association between treatments and outcomes, nested case-control analyses matching patients to controls (maximum of 1:10 ratio) according to index age, sex, index year, and follow-up duration were performed. Results Among 40322, 4953 and 5347 patients with AS, PsA and PsO, respectively, three different datasets were generated to evaluate incidence of outcomes. Conditional logistic regression analysis revealed that cyclosporine use (odds ratio [OR] 2.286, p=0.0176) increased cancer, and a higher Charlson Comorbidity Index (CCI) score (OR 1.085, p=0.0406) and IL-17 inhibitor use only (OR 0.126, p=0.0457) showed a positive and negative association with TB, respectively. Serious infections increased in patients with high CCI scores (OR 1.117, p<0.0001), cyclosporine users (OR 1.445, p=0.0098), and medical-aided individuals (OR 1.667, p<0.0001). Conclusion In this nationwide cohort of IL-17 and TNF-alpha inhibitor users, both treatments conferred comparable risk of cancer and serious infections, while IL-17 inhibitors may be advantageous for TB.