Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
College of Traditional Chinese Medicine of Chongqing Medical University, Chongqing, China.
J Eur Acad Dermatol Venereol. 2023 Dec;37(12):2509-2516. doi: 10.1111/jdv.19394. Epub 2023 Aug 9.
Atopic-like dermatitis (ALD) is a common side effect of interleukin-17A (IL-17A) inhibitors.
To determine the prevalence, risk factors, outcomes and treatment of ALD in a cohort of psoriasis patients treated with IL-17A inhibitors.
This retrospective study included 226 psoriasis patients treated with an IL-17A inhibitor in our dermatology department between July 2020 and July 2022. The patients were reviewed over 2 years. A logistic regression model in rare events data (relogit) was used to predict the risk factors for ALD.
Of the 226 patients, 14 had ALD. Data including age, body mass index, IL-17A inhibitor use, personal and family history of atopic disease, pet ownership history, and immunoglobulin E (IgE) levels were analysed using the relogit regression model. It indicated a personal history of atopic disease (odd ratio [OR] 27.830, 95% confidence interval [CI] 3.801-203.770; p = 0.001) and elevated IgE levels (OR 5.867, 95% CI 1.131-30.434; p = 0.035) as independent predictors of incident ALD. In one patient, anti-IL-17A therapy was discontinued, and treatment was switched to tofacitinib. Thirteen patients who continued with IL-17A inhibitor were treated with topical therapy and/or antihistamines, and their ALD was partially or completely resolved.
In this study, the incidence rate of ALD was 6.19%. Elevated IgE levels and a personal history of atopic disease were found to be the risk factors for ALD. Our study findings suggest that treatment should be provided based on the severity of psoriasis and incident ALD. Prior to treatment, psoriasis patients who have the risk factors for ALD should be informed of the possible development of ALD, and alternative psoriatic therapeutic options should be considered if severe ALD develops.
特应性皮炎（ALD）是白细胞介素-17A（IL-17A）抑制剂的常见副作用。
确定接受 IL-17A 抑制剂治疗的银屑病患者队列中 ALD 的患病率、危险因素、结局和治疗方法。
这项回顾性研究纳入了 2020 年 7 月至 2022 年 7 月期间在我们皮肤科接受 IL-17A 抑制剂治疗的 226 例银屑病患者。对这些患者进行了为期 2 年的随访。采用稀有事件数据的逻辑回归模型（relogit）预测 ALD 的危险因素。
在 226 例患者中，有 14 例患有 ALD。使用 relogit 回归模型对年龄、体重指数、IL-17A 抑制剂使用、特应性疾病个人和家族史、宠物饲养史和免疫球蛋白 E（IgE）水平等数据进行分析。结果表明，特应性疾病个人史（比值比 [OR] 27.830，95%置信区间 [CI] 3.801-203.770；p=0.001）和升高的 IgE 水平（OR 5.867，95%CI 1.131-30.434；p=0.035）是发生 ALD 的独立预测因素。1 例患者停用抗 IL-17A 治疗，改为托法替尼治疗。13 例继续使用 IL-17A 抑制剂的患者接受了局部治疗和/或抗组胺治疗，其 ALD 部分或完全缓解。
在这项研究中，ALD 的发病率为 6.19%。升高的 IgE 水平和特应性疾病个人史被发现是 ALD 的危险因素。我们的研究结果表明，应根据银屑病的严重程度和发生的 ALD 来提供治疗。在治疗前，应告知有 ALD 风险的银屑病患者可能会发生 ALD，如果发生严重的 ALD，应考虑替代的银屑病治疗选择。
