Risk of Paradoxical Eczema in Patients Receiving Biologics for Psoriasis.
Risk of Paradoxical Eczema in Patients Receiving Biologics for Psoriasis.
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DOI：
10.1001/jamadermatol.2023.4846
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发表时间：
2024-01-01
期刊：
影响因子：
10.9
通讯作者：
Warren, Richard B.
中科院分区：
文献类型：
--
作者：
Al-Janabi, Ali;Alabas, Oras A.;Yiu, Zenas Z. N.;Foulkes, Amy C.;Eyre, Steve;Khan, Adnan R.;Reynolds, Nick J.;Smith, Catherine H.;Griffiths, Christopher E. M.;Warren, Richard B.
本队列研究探讨了哪些生物药物类别和因素与接受生物药物治疗的牛皮癣患者发生异位性湿疹的风险相关。用生物制剂治疗的牛皮癣患者发生反常湿疹与哪些因素相关？在这项对13699名银屑病患者进行24997次生物暴露的队列研究中，与其他生物类别相比，接受白介素23抑制剂的患者发生悖论性湿疹的风险最低。年龄增长、特应性皮炎史和花粉热史与悖论性湿疹的高风险相关；男性患病风险较低。研究结果表明，白细胞介素23抑制剂可以考虑银屑病患者与矛盾湿疹相关的因素。据报道，用于斑块型银屑病的生物制剂与一些患者的特应性皮炎（AD）表型或反常湿疹有关。其风险因素尚不清楚。目的：探讨异型湿疹的生物学危险性，确定异型湿疹的相关因素。这项前瞻性队列研究使用了来自英国皮肤科医师协会生物制剂和免疫调节剂登记册的数据，用于在英国和爱尔兰的多中心皮肤科诊所接受生物制剂治疗斑块性银屑病的成年人。纳入的参与者在2007年9月至2022年12月期间进行了1次或1次以上的随访。暴露于肿瘤坏死因子（TNF）抑制剂、白细胞介素（IL） 17抑制剂、IL-12/23抑制剂或IL-23抑制剂的持续时间，直至反常湿疹发作、停止治疗、最后一次随访或死亡。使用倾向评分加权Cox比例风险回归模型评估悖论性湿疹的发病率、生物学类别的悖论性湿疹风险，以及人口学和临床变量与悖论性湿疹风险的关联。在考虑的56 553种药物暴露中，包括13 699名参与者中的24 997名。24997例暴露（中位年龄46岁[IQR， 36-55岁]，57%为男性）累计总暴露时间为81441患者年。273例（1%）暴露与矛盾性湿疹有关。IL-17抑制剂调整后的发病率为1.22 / 10万人年，TNF抑制剂为0.94 / 10万人年，IL-12/23抑制剂为0.80 / 10万人年，IL-23抑制剂为0.56 / 10万人年。与TNF抑制剂相比，IL-23抑制剂与较低的悖论性湿疹风险相关（风险比[HR]， 0.39; 95% CI, 0.19-0.81）， IL-17抑制剂（风险比[HR]， 1.03; 95% CI, 0.74-1.42）或IL-12/23抑制剂（风险比，0.87;95% CI, 0.66-1.16）与悖论性湿疹风险无关。年龄增加（相对危险度，1.02 /年；95% CI, 1.01-1.03）、AD病史（相对危险度，12.40;95% CI, 6.97-22.06）或花粉热（相对危险度，3.78;95% CI, 1.49-9.53）与悖论性湿疹的高风险相关。男性的风险较低（HR, 0.60; 95% CI, 0.45-0.78）。在这项研究中，在接受生物治疗的银屑病患者中，接受IL-23抑制剂的患者患湿疹的风险最低。年龄、女性、AD或花粉热病史与悖论性湿疹的高风险相关。悖论性湿疹的总体发病率较低。需要进一步的研究来重复这些发现。
This cohort study examines which biologic drug classes and factors are associated with risk of paradoxical eczema in patients with psoriasis treated with biologics. What factors are associated with paradoxical eczema occurring in patients with psoriasis treated with biologics? In this cohort study of 24 997 biologic exposures in 13 699 patients with psoriasis, risk of paradoxical eczema was lowest in patients receiving interleukin 23 inhibitors compared with other biologic classes. Increasing age, history of atopic dermatitis, and history of hay fever were associated with higher risk of paradoxical eczema; risk was lower in males. The findings suggest that interleukin 23 inhibitors could be considered in patients with psoriasis with factors associated with paradoxical eczema. 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. To explore risk of paradoxical eczema by biologic class and identify factors associated with paradoxical eczema. 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. 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. 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. Of 56 553 drug exposures considered, 24 997 from 13 699 participants were included. The 24 997 included exposures (median age, 46 years [IQR, 36-55 years]; 57% male) accrued a total exposure time of 81 441 patient-years. A total of 273 exposures (1%) were associated with paradoxical eczema. The adjusted incidence rates were 1.22 per 100 000 person-years for IL-17 inhibitors, 0.94 per 100 000 person-years for TNF inhibitors, 0.80 per 100 000 person-years for IL-12/23 inhibitors, and 0.56 per 100 000 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). 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.
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影响因子：
10.3
作者：
Ryan, C.;Menter, A.;Bleakman, A. Potts
通讯作者：
Bleakman, A. Potts
影响因子：
3.1
作者：
Ohtsuki, Mamitaro;Morita, Akimichi;Nakagawa, Hidemi
通讯作者：
Nakagawa, Hidemi
影响因子：
1.4
作者：
Sehgal, Rahul;Stratman, Erik J.;Cutlan, Jonathan E.
通讯作者：
Cutlan, Jonathan E.
影响因子：
--
作者：
Jay R;Rodger J;Zirwas M
通讯作者：
Zirwas M
影响因子：
9.8
作者：
Baurecht H;Hotze M;Brand S;Büning C;Cormican P;Corvin A;Ellinghaus D;Ellinghaus E;Esparza-Gordillo J;Fölster-Holst R;Franke A;Gieger C;Hubner N;Illig T;Irvine AD;Kabesch M;Lee YA;Lieb W;Marenholz I;McLean WH;Morris DW;Mrowietz U;Nair R;Nöthen MM;Novak N;O'Regan GM;Psoriasis Association Genetics Extension;Schreiber S;Smith C;Strauch K;Stuart PE;Trembath R;Tsoi LC;Weichenthal M;Barker J;Elder JT;Weidinger S;Cordell HJ;Brown SJ
通讯作者：
Brown SJ