Interleukin-23 inhibitors exhibit lowest paradoxical eczema risk in psoriasis treatment

Key takeaways:

• IL-23 inhibitors were associated with the lowest incidences of paradoxical eczema.
• Increasing age, female sex and history of atopic dermatitis and hay fever were associated with higher incidence risk.

While certain demographic factors were associated with a higher risk for paradoxical eczema among patients with psoriasis, treatment with certain biologic classes was not, according to a study.

“While biologics targeting tumor necrosis factor (TNF), interleukin (IL)-12/23, IL-17 and IL-23 are highly effective treatments for plaque psoriasis, they are associated with cutaneous adverse events, such as paradoxical psoriasis, cutaneous lupus and granulomatous disorders,” Ali Al-Janabi, MA, of the division of musculoskeletal and dermatological sciences at The University of Manchester Faculty of Biology Medicine and Health, and colleagues wrote. “Some patients with psoriasis develop paradoxical eczema, an atopic dermatitis (AD) phenotype, during biologic exposure because these dermatoses are genetically and immunologically divergent and rarely occur together.”

To investigate the biologic classes associated with paradoxical eczema in patients with psoriasis, the authors conducted a prospective cohort study using data from the British Association of Dermatologists Biologics and Immunomodulators Register.

Results showed that of 24,997 drug exposures from 13,699 participants, a total of 273 (1%) of exposures were associated with paradoxical eczema.

The drug class with the highest adjusted incidence rates was IL-17 inhibitors at 1.22 per 100,000 person-years followed by 0.94 for TNF inhibitors, 0.8 for IL-12/23 inhibitors, and 0.56 for IL-23 inhibitors.

When comparing the risk for paradoxical eczema among these drug classes, the researchers found that IL-23 inhibitors were associated with a lower risk for paradoxical eczema than TNF inhibitors (HR = 0.39; 95% CI, 0.19-0.81). IL-17 inhibitors (HR = 1.03; 95% CI, 0.74-1.42) and IL-12/23 inhibitors (HR = 0.87; 95% CI, 0.66-1.16) showed no significant association with a risk for paradoxical eczema.

Individuals were at a higher risk for paradoxical eczema as they aged (HR = 1.02 per year; 95% CI, 1.01-1.03) and if they had a history of AD (HR, 12.4; 95% CI, 6.97-22.06) or hay fever (HR, 3.78; 95% CI, 1.49-9.53). On the other hand, there was a lower risk for paradoxical eczema in male participants (HR = 0.6; 95% CI, 0.45-0.78).

“In this study, there was a lower risk of paradoxical eczema among participants receiving IL-23 inhibitors,” the authors wrote. “Factors associated with paradoxical eczema included increasing age, female sex, history of AD and history of hay fever.”