key: cord-0880257-ad36irmp
authors: Wan, Marilyn T.; Shin, Daniel B.; Winthrop, Kevin L.; Gelfand, Joel M.
title: Reply to: “Do IL-17 Inhibitors Increase Risk of Respiratory Tract Infections?”
date: 2020-07-02
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.06.1001
sha: 92f0380031183f5dab354cb6907507bf6a6260d9
doc_id: 880257
cord_uid: ad36irmp

nan

Letter to the Editor 1 2 To the Editor: We thank Drs. Blauvelt and Ehst for their comments 1 about the meta- 3 estimate we reported, in which there was a higher risk of developing respiratory tract 4 infections (RTIs) in patients with psoriasis treated with interleukin (IL)-17 targetting 5 biologics compared to placebo. 2 RTIs which are usually innocuous infections, have 6 become of special interest since the pandemic caused by SARS-CoV-2. Therefore, we 7 conducted a meta-estimate to rigorously determine if there is a safety signal for RTI with 8 biologics that target IL-17. Blauvelt and Ehst suggest grouping secukinumab and ixekizumab (which block IL-17A) 11 with brodalumab (which blocks IL-17RA) may be inappropriate as brodalumab has a 12 broader mechanism of action, which could lead to differential infectious consequences. 13 Interestingly, brodalumab (OR 2.14, 95%CI 1.17-3.89) did have the highest RTI risk. 14 Inconsistent with this hypothesis, however, is that rates of RTI in secukinumab (OR 1.84, 15 95%CI 1.33-2.5) appeared more similar to broadalumab, with ixekizumab (OR 1.11, 95% 16 CI: 0.85-1.45) being the outlier. We agree further study is warranted. Fourth, Blauvelt and Ehst raise concerns about labeling biologics used for psoriasis as 35 "immunosuppressives" and state this terminology can lead to misplaced "fear of 36 biologics." While we appreciate the authors' concern, we are merely using the 37 terminology applied by the Food and Drug Administration. 4 38 39

Finally, we appreciate that Blauvelt and Ehst share their opinion that IL-17 inhibitors do 40 not increase the risk of developing RTIs based on their clinical experience. We, too, have 41 treated hundreds of patients with IL-17 inhibitors. We are humbled to know that clinical experience alone is insufficient to determine these risks, 5 and therefore, our lab is 43 committed to providing our colleagues and patients with the best, most rigorous 44 assessments of available data combined with a measured interpretation of the results. We 45 certainly agree with Blauvelt and Ehst that more meticulous evaluation of the risk of 46 RTIs associated with various classes of biologics used to treat psoriasis is needed.

Do IL-17 Inhibitors Increase Risk of Respiratory Tract Infections

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