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Medscape
10 hours ago
- Health
- Medscape
Dupilumab Linked to Higher Psoriasis Risk in AD
Treating atopic dermatitis (AD) with dupilumab vs other systemic agents increased the risk of developing psoriasis over 3 years, a cohort study found. METHODOLOGY: Addressing postmarketing reports of psoriasis in patients treated with dupilumab for AD, researchers conducted a population-based retrospective cohort study of 214,430 adults with AD from the TriNetX Global Collaborative Network, with a 3-year follow-up. Analyses were completed on October 19, 2024. The study compared 9860 adults newly prescribed dupilumab vs 9860 prescribed other systemic agents, which were corticosteroids, methotrexate, cyclosporine, azathioprine, or mycophenolate mofetil. The mean age in both groups was about 45 years; about 55% were women; about half were White, 18% were Black, and 10% were Asian. The primary outcome measure was incident psoriasis, and the secondary outcome was psoriatic arthritis (PsA). TAKEAWAY: Over 3 years, 2.0% of patients on dupilumab developed psoriasis vs 1.1% of those taking other systemic agents ( P < .001). < .001). Psoriasis risk was significantly higher in patients on dupilumab (hazard ratio [HR], 1.58; 95% CI, 1.25-1.99). The number needed to harm (NNH) for psoriasis was 94 for dupilumab vs the other systemic agents. Psoriasis risk was also higher in patients on dupilumab who were older than 60 years (HR, 1.77; 95% CI, 1.22-2.58), men (HR, 1.55; 95% CI, 1.08-2.22), women (HR, 1.63; 95% CI, 1.19-2.24), and White (HR, 1.43; 95% CI, 1.05-1.93). At 3 years, PsA incidence with dupilumab vs other systemic agents was similar (0.20% vs 0.13%; P = .53). The risk was not statistically significant (HR, 1.97; 95% CI, 0.75-5.18). IN PRACTICE: The study found an increased relative risk for psoriasis among those treated with dupilumab, the study authors wrote, adding that an estimated NNH of 94 reflected the limited clinical relevance of the absolute risk, and 'risk should be weighed against dupilumab's proven efficacy in treating AD.' They noted that the rate of psoriasis was in the range of psoriasis prevalence in general AD populations, suggesting that 'dupilumab may act more as a trigger rather than a decisive factor in promoting psoriatic eruption in patients with AD.' SOURCE: The study was led by Teng-Li Lin, MD, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation in Chiayi, Taiwan. It was published online on June 18 in JAMA Dermatology . LIMITATIONS: Limitations included the observational design, possible misclassification bias in outcome reporting, and absence of information on AD severity, physician specialties, photodocumentation, and treatment response. Because the database only supported time-fixed medication exposure analyses, data on dosage, duration, and adherence were unavailable. DISCLOSURES: The research received support from the National Science Technology Council and Taichung Veterans General Hospital, both in Taiwan. The authors had no competing interests.
Medscape
a day ago
- Health
- Medscape
Severe Neonatal Illness Predicts Mortality Into Adolescence
Severe neonatal morbidity (SNM) significantly increased the risk for death from infancy through late adolescence, particularly for neurologic conditions. Female infants and those born term with SNM faced higher relative mortality risks. METHODOLOGY: Researchers conducted a population-based cohort study using data from the Swedish Medical Birth Register to assess the association between SNM and all-cause and cause-specific mortality from infancy to adolescence. This study included 2,098,752 live-born singleton infants born between 2002 and 2021, of whom 49,225 (2.4%) were diagnosed with SNM (defined as respiratory infections or neurologic or procedural complications within 27 days of birth). Mortality was classified on the basis of age as infancy (28 days to 11 months), early childhood (1-4 years), later childhood (5-9 years), and adolescence (≥ 10 years). Primary outcomes were all-cause and cause-specific mortality from 28 days to a follow-up duration of 21.2 years. TAKEAWAY: The mortality rate was 1.81 vs 0.13 per 1000 person-years among children with SNM vs those without SNM (adjusted hazard ratio [aHR], 5.92; 95% CI, 5.27-6.64). Neurologic morbidity had the strongest association (aHR, 17.67; 95% CI, 15.08-20.71). Female children with SNM had a higher risk for mortality than male children (aHR, 7.28 vs 4.97; P for interaction < .001), with the association between SNM and neurologic morbidity notably stronger among female children. for interaction < .001), with the association between SNM and neurologic morbidity notably stronger among female children. Among children aged 1 year or older, SNM was strongly associated with deaths from neurologic diseases (aHR, 18.64; 95% CI, 12.51-27.79), circulatory diseases (aHR, 5.41; 95% CI, 2.67-10.94), and metabolic disorders (aHR, 3.56; 95% CI, 1.70-7.44). Among children with SNM, those born preterm had higher absolute mortality rates than those born term (2.76 vs 1.30 per 1000 person-years); however, infants born term showed a stronger relative risk than those born preterm (aHR, 7.16 vs 3.51). IN PRACTICE: "Efforts to further prevent severe neonatal morbidity, ensure early identification, and provide long-term follow-up care may help reduce mortality and inform discussions with families regarding prognosis and follow-up needs," the authors wrote. SOURCE: This study was led by Hillary Graham, MS, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. It was published online on June 10, 2025, in JAMA Pediatrics . LIMITATIONS: This study included over 20 years of follow-up; mortality data became limited beyond 15 years. Lower early-life survival in the earliest birth cohort may have led to survivor bias, potentially underestimating the long-term risk for mortality. Although the sibling-controlled analysis helps address familial confounding, it may still be affected by unmeasured differences between siblings. DISCLOSURES: This study was supported by grants from the Swedish Research Council and Stockholm City Council, ALF Medicine. The authors reported having no conflicts of interest.
