IL-23 inhibitors may have a lower risk of paradoxical eczema in comparison to other biologics - 2 Minute Medicine

1. Interleukin-23 inhibitors had a lower risk of developing paradoxical eczema when treated for plaque psoriasis compared to TNF inhibitors, IL-17 inhibitors and IL-12/23

2. Clinical features associated with increased paradoxical eczema risks included increasing age, history of atopic dermatitis, and history of hay fever. The risk was also lower in males.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Biologics targeting tumour necrosis factor (TNF) and various interleukins effectively treat plaque psoriasis but are linked to adverse events such as paradoxical psoriasis, cutaneous lupus, and granulomatous disorders. Reports have also shown the development of paradoxical eczema during biological exposure. However, it needs to be clarified whether the risk of developing eczema varies across clinical features and different classes of biologics. Therefore, this prospective study evaluated three primary outcomes: (1) the incidence of paradoxical eczema as a whole and specific to biologic class, (2) the risk of developing paradoxical eczema between TNF inhibitors and other classes of biologics, and (3) demographic and clinical factors that influence paradoxical eczema. A lower risk of paradoxical eczema was seen among patients treated for plaque psoriasis with IL-23 inhibitors. An increased risk of paradoxical eczema was seen for the clinical features of increasing age and history of atopic dermatitis and hay fever. Lower risk was seen for males. Limitations included the small subgroup sample sizes (e.g., specific biologic exposures and ethnic minority groups). There was also a risk of adverse event misclassification as ascertainment relied on text descriptions from medical records. It was also not possible to directly attribute an adverse event to that of the biologic.

Click to read the study in JAMA Dermatology.

Relevant Reading: Eczematous eruption during anti0interluekin 17 treatment fo psoriasis: an emerging condition

In-Depth [prospective cohort]: This prospective cohort study was completed under the ethics approval of the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR), which has over 20,000 patients with psoriasis from 168 centres in the UK and Ireland. Patients were included from September 2007 to December 2022 if they met the following criteria: 18 years or older, diagnoses of plaque psoriasis, and exposure to one or more biologics. The biologics included in this study were TNF inhibitors, IL-17 inhibitors, IL-12/23 inhibitors, and IL-23 inhibitors. Systemic therapy start and stop dates, baseline comorbidities/demographics, and adverse event data were collected. To assess for exposures (i.e., paradoxical eczema onset, treatment switch or discontinuation, last documented follow-up, and death), patients were followed every six months for the first three years, then annually afterwards. Of 56,553 drug exposure initially considered, 24,997 (13,699 patients; median age, 46 years [IQR, 36-55 years]; 57% male) were included. Of the 24,997 exposures, 273 (1%) were associated with paradoxical eczema. The incidence (per 100,000 person-years) was 1.22 for IL-17 inhibitors, 0.94 for TNF inhibitors, 0.80 for IL-12/23 inhibitors, and 0.56 for IL-23 inhibitors. IL-23 inhibitors had a lower risk of paradoxical eczema (hazard ratio [HR], 0.39; 95% CI, 0.19-0.81) than TNF inhibitors. Whereas IL-17 (HR, 1.03; 95% CI, 0.74-1.42) and IL-12/23 inhibitors (HR, 0.87; 95% CI, 0.66-1.16) had no associated risk for paradoxical eczema. Clinical features that were associated with a higher risk of paradoxical eczema were increasing age (HR, 1.02 per year; 95% CI, 1.01-1.03), history of atopic dermatitis (HR, 12.40; 95% CI, 6.97-22.06), and history of hay fever (HR, 3.78; 95% CI, 1.49-9.53). A lower risk was seen for males (HR, 0.60; 95% CI, 0.45-0.78) than females. Overall, paradoxical eczema risk in patients treated with biologics for plaque psoriasis was lowest in patients receiving IL-23 inhibitors.

Image: PD

©2023 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Adblock test (Why?)

Comments

Post a Comment

Popular posts from this blog

Rashes that look like scabies: Causes, symptoms, and treatment - Medical News Today

Image
Scabies is a skin condition that occurs as the result of a mite known as Sarcoptes scabiei. The rash that results from scabies may appear similar to other skin conditions, such as psoriasis, eczema, or contact dermatitis. In this article, we look at what a scabies rash looks like. We also look at other rashes that are similar in appearance and their treatment options. Scabies is a common condition that occurs as the result of an infestation of a microscopic skin mite called Sarcoptes scabiei. The mites burrow under the skin, causing intense itching and a rash. The Centers for Disease Control and Prevention (CDC) describes the rash as pimple-like. On darker skin, the rash may be more difficult to see, but a person should be able to feel it. According to DermNet, a scabies rash is varied in appearance, and may appear as: pimple-like on the limbs and trunk widespread or coin-shaped small blisters scales lesions in the armpits, groin, navel, areolas, scrotum, buttocks, and along the penil...
Read more

Urinary Tract Infection (UTI): Causes, Symptoms & Treatment - Cleveland Clinic

Image
Can I prevent a urinary tract infection? The following lifestyle changes can help prevent urinary tract infections: Practice good hygiene Practicing good hygiene is one of the best ways to help prevent UTIs. This is especially important if you have a vagina because your urethra is much shorter, and it's easier for E. coli to move from your rectum back into your body. Always wipe from front to back after a bowel movement (pooping) to avoid this. During your menstrual cycle, it's also a good idea to regularly change your period products, including pads and tampons. You should also avoid using any deodorants on your vagina. Drink plenty of fluids Drinking extra fluids — especially water — each day can help flush out bacteria from your urinary tract. Healthcare providers recommend drinking six to eight glasses of water daily. Change your peeing habits Peeing can play a big role in getting rid of bacteria from your body. Your pee is a waste product, and each time you empty your bla...
Read more

Symtuza: Uses, side effects, alternatives, and more - Medical News Today

Image
The Food and Drug Administration (FDA) approves prescription drugs such as Symtuza to treat certain conditions. Symtuza is FDA-approved to treat HIV-1 in adults and children who weigh at least 40 kilograms (kg), which is about 88 pounds (lb). It's approved for people who: have just been diagnosed with HIV and haven't started treatment yet, OR are changing from another HIV treatment and: have been on a stable antiretroviral regimen for at least 6 months (this means you haven't had any changes to your HIV drugs for at least 6 months) have a viral load (the amount of HIV in your blood) that's less than 50 copies per milliliter (mL) have HIV that doesn't have mutations (changes) that could make it resistant (less likely to respond) to darunavir or tenofovir (two of the active drugs in Symtuza) HIV explained HIV stands for human immunodeficiency virus. There are two forms of this virus, HIV-1 and HIV-2. HIV-1 is the most common form. HIV is transmitted through body fluid...
Read more