Risk of Paradoxical Eczema in Patients Receiving Biologics for Psoriasis

In cohort study (n=13,699 with 24,997 biologic exposures), 273 exposures (1%) were linked to paradoxical eczema (PEZ), with lowest risk in patients on IL-23 inhibitors vs. other biologics. Increasing age, history of atopic dermatitis, & hay fever linked to higher risk of PEZ.

SPS commentary:

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
  • 0.56 per 100 000 person-years for IL-23 inhibitors

Compared with TNF inhibitors, IL-23 inhibitors were associated with a lower risk (HR 0.39; 95% CI, 0.19-0.81), and there was no association of IL-17 inhibitors or IL-12/23 inhibitors with risk of paradoxical eczema.

JAMA Dermatology