Oral Candidiasis Associated with Longer Psoriasis Duration, Study Finds

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Development of oral candidiasis is linked with a longer duration of psoriasis among individuals who have been treated with bimekizumab, according to recent findings.¹

These data were the conclusion of a recent analysis that evaluated those treated with bimekizumab, a humanized monoclonal immunoglobulin (Ig) G1 antibody. The medication was formulated to target interleukin (IL)-17A and IL-17F in those with psoriasis, and it has been approved for treatment of moderate-to-severe disease.

“Previous studies have demonstrated its high efficacy, but bimekizumab is associated with a higher incidence of oral candidiasis than other IL-17 inhibitors,” Toneyama and colleagues wrote. “However, predictive factors for oral candidiasis remain unclear in psoriasis patients treated with bimekizumab. We aimed to identify such predictive factors.”^1,2

Background and Findings

The investigative team conducted their research using a retrospective trial design, evaluating 58 Japanese patients who had been given a psoriasis diagnosis. The team noted that 70.7% of these participants were male and all were treated with bimekizumab at a dosage of 320 mg on an every-4-week basis until the 16-week mark.

The researchers highlighted that none of those enrolled in this analysis reported a prior history of oral candidiasis.

A total of 24 individuals, after the initial period, continued with the every-4-week therapy regimen, and 34 switched to an every-8-week regimen. The median duration of bimekizumab treatment was 60 weeks, ranging from 46 to 84 weeks.

During the course of treatment, the investigators reported that 15.5% of their subjects were shown to have developed oral candidiasis. They added that there was a median time of onset of 16 weeks, with a range between 12 - 28 weeks among those being assessed.

An evaluation of baseline laboratory and clinical parameters, along with background information on participants, was carried out to better understand the occurrence of candidiasis. These parameters were then compared between the participants who ended up with oral candidiasis and those who did not develop the condition.

The researchers did not identify any other statistically significant distinction for other baseline comorbidities, laboratory or clinical parameters, or background factors. They did not find any significant differences in study subjects’ Psoriasis Area and Severity Index (PASI) improvement rates at either the 16 or 52-week marks when they compared those who did and did not develop oral candidiasis.

In 1 notable finding from the team’s analysis, it was reported that individuals showing oral candidiasis were found to have a longer duration of psoriasis compared to subjects who did not (P = .0372). The investigators’ receiver operating characteristic curve analysis indicated a moderate predictive ability of patients’ duration of disease for the development of oral candidiasis, yielding an area under the curve of 0.722 (95% CI: 0.561–0.884).

In their analysis, the research team identified a cut-off value of 20 years for the duration of patients’ disease.

In a set of previous phase 3 findings, the occurrences of oral candidiasis in those with psoriasis who were given bimekizumab as a treatment was reported among 15.6% and 19.3% in each of the 2 clinical trials, respectively. The current study’s incidence rate of 15.5% aligns closely with those data.

Overall, this study provides evidence to support that those being given prolonged immunosuppressive therapy may face an increased risk of developing such a condition.

“This was a single-center study with a small sample size, limited to Japanese patients,” they wrote. “In real-world practice, clinicians should be more cautious about oral candidiasis when administering bimekizumab to psoriasis patients with longer disease duration, particularly those aged ≥20 years.”¹

References

1. ^{Yoneyama, M., Hagino, T., Saeki, H., Fujimoto, E. and Kanda, N. (2025), A predictive factor of oral candidiasis in psoriasis patients treated with bimekizumab: Longer disease duration. J Dermatol. https://doi.org/10.1111/1346-8138.17623.}
2. ^{Bilal H, Khan MN, Khan S, Fang W, Chang W, Yin B, et al. Risk of candidiasis associated with interleukin-17 inhibitors: implications and management. Mycology. 2024; 15: 30–44.}