Published in Dermatology

Journal Scan / Research · June 20, 2019

Comparative Safety of Systemic Immuno-Modulatory Medications in Adults With Atopic Dermatitis

TAKE-HOME MESSAGE

• The incidence of serious bacterial or opportunistic infections in over 1 million patients with atopic dermatitis (AD) who were using systemic treatment was calculated using a US commercial insurance claims database. The rate of serious infections in patients using nonbiologic systemic immunomodulators was not statistically different from the rate in those treated with phototherapy. In pairwise comparison with methotrexate, prednisone and mycophenolate were associated with nearly double and triple the rates of serious infections, azathioprine with higher rates of infections, and cyclosporine with fewer infections.

• However, as a group, there was no difference in infection rate compared with patients on phototherapy.

– Margaret Hammond, MD

BACKGROUND

Severe atopic dermatitis (AD) is increasingly treated with systemic immuno-modulatory drugs yet their safety is unclear.

OBJECTIVE

We evaluated the comparative risk of serious bacterial and opportunistic infections among users of systemic immuno-modulatory medications in patients with severe AD in routine care.

METHODS

In a population-based claims data study we identified adult patients with AD who were treated with systemic drugs. The incidence of serious bacterial and opportunistic infections leading to hospitalization was computed using ICD diagnosis codes. Relative risks were computed after 1:1 propensity score matching.

RESULTS

Up to 232,611 patients with AD were eligible. The incidence of serious infections was 7.53 per 1,000 (7.18-7.89) among systemic non-biologics and 7.38 per 1,000 (5.68-9.57) among phototherapy treated patients, and 2.6 per 1,000 (0.45-14.3) dupilumab users. After matching, compared to methotrexate, cyclosporine had significantly reduced 6-month risk (RR=0.87), while prednisone, azathioprine and mycophenolate showed increased risks (RR= 1.78, 1.89 and 3.31, respectively). Small numbers of dupilumab users showed no increase in risk (RR=0.33; 0.03 - 3.20).

CONCLUSION

In this population-based study of adult AD patients, cyclosporine and methotrexate have the lowest 6-month risks of serious infections. Increased risks were observed for prednisone, azathioprine, and mycophenolate relative to methotrexate.

Journal of the American Academy of Dermatology

Comparative Safety of Systemic Immuno-Modulatory Medications in Adults With Atopic Dermatitis

J Am Acad Dermatol 2019 May 31;[EPub Ahead of Print], MC Schneeweiss, L Perez-Chada, JF Merola 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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