Risk of Paradoxical Eczema in Patients Receiving Biologics for Psoriasis.
JAMA Dermatol
; 160(1): 71-79, 2024 Jan 01.
Article
in En
| MEDLINE
| ID: mdl-38055239
ABSTRACT
Importance Biologics used for plaque psoriasis have been reported to be associated with an atopic dermatitis (AD) phenotype, or paradoxical eczema, in some patients. The risk factors for this are unknown. Objective:
To explore risk of paradoxical eczema by biologic class and identify factors associated with paradoxical eczema. Design, Setting, andParticipants:
This prospective cohort study used data from the British Association of Dermatologists Biologics and Immunomodulators Register for adults treated with biologics for plaque psoriasis who were seen at multicenter dermatology clinics in the UK and Ireland. Included participants were registered and had 1 or more follow-up visits between September 2007 and December 2022. Exposures Duration of exposure to tumor necrosis factor (TNF) inhibitors, interleukin (IL) 17 inhibitors, IL-12/23 inhibitors, or IL-23 inhibitors until paradoxical eczema onset, treatment discontinuation, last follow-up, or death. Main Outcomes andMeasures:
Incidence rates of paradoxical eczema, paradoxical eczema risk by biologic class, and the association of demographic and clinical variables with risk of paradoxical eczema were assessed using propensity score-weighted Cox proportional hazards regression models.Results:
Of 56â¯553 drug exposures considered, 24â¯997 from 13â¯699 participants were included. The 24â¯997 included exposures (median age, 46 years [IQR, 36-55 years]; 57% male) accrued a total exposure time of 81â¯441 patient-years. A total of 273 exposures (1%) were associated with paradoxical eczema. The adjusted incidence rates were 1.22 per 100â¯000 person-years for IL-17 inhibitors, 0.94 per 100â¯000 person-years for TNF inhibitors, 0.80 per 100â¯000 person-years for IL-12/23 inhibitors, and 0.56 per 100â¯000 person-years for IL-23 inhibitors. Compared with TNF inhibitors, IL-23 inhibitors were associated with a lower risk of paradoxical eczema (hazard ratio [HR], 0.39; 95% CI, 0.19-0.81), and there was no association of IL-17 inhibitors (HR, 1.03; 95% CI, 0.74-1.42) or IL-12/23 inhibitors (HR, 0.87; 95% CI, 0.66-1.16) with risk of paradoxical eczema. Increasing age (HR, 1.02 per year; 95% CI, 1.01-1.03) and history of AD (HR, 12.40; 95% CI, 6.97-22.06) or hay fever (HR, 3.78; 95% CI, 1.49-9.53) were associated with higher risk of paradoxical eczema. There was a lower risk in males (HR, 0.60; 95% CI, 0.45-0.78). Conclusions and Relevance In this study, in biologic-treated patients with psoriasis, paradoxical eczema risk was lowest in patients receiving IL-23 inhibitors. Increasing age, female sex, and history of AD or hay fever were associated with higher risk of paradoxical eczema. The overall incidence of paradoxical eczema was low. Further study is needed to replicate these findings.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Psoriasis
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Biological Products
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Eczema
Limits:
Adult
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Female
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Humans
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Male
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Middle aged
Language:
En
Journal:
JAMA Dermatol
Year:
2024
Document type:
Article