{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T06:42:06Z","timestamp":1793256126705,"version":"4.5.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:sec id=\"ab-doi230059-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Biologics used for plaque psoriasis have been reported to be associated with an atopic dermatitis (AD) phenotype, or paradoxical eczema, in some patients. The risk factors for this are unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230059-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore risk of paradoxical eczema by biologic class and identify factors associated with paradoxical eczema.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230059-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This prospective cohort study used data from the British Association of Dermatologists Biologics and Immunomodulators Register for adults treated with biologics for plaque psoriasis who were seen at multicenter dermatology clinics in the UK and Ireland. Included participants were registered and had 1 or more follow-up visits between September 2007 and December 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230059-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Duration of exposure to tumor necrosis factor (TNF) inhibitors, interleukin (IL) 17 inhibitors, IL-12\/23 inhibitors, or IL-23 inhibitors until paradoxical eczema onset, treatment discontinuation, last follow-up, or death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230059-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Incidence rates of paradoxical eczema, paradoxical eczema risk by biologic class, and the association of demographic and clinical variables with risk of paradoxical eczema were assessed using propensity score\u2013weighted Cox proportional hazards regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230059-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 56\u202f553 drug exposures considered, 24\u202f997 from 13\u202f699 participants were included. The 24\u202f997 included exposures (median age, 46 years [IQR, 36-55 years]; 57% male) accrued a total exposure time of 81\u202f386 patient-years. A total of 273 exposures (1%) were associated with paradoxical eczema. The adjusted incidence rates were 4.45 per 1000 person-years for IL-17 inhibitors, 3.43 per 1000 person-years for TNF inhibitors, 2.92 per 1000 person-years for IL-12\/23 inhibitors, and 2.04 per 1000 person-years for IL-23 inhibitors. Compared with TNF inhibitors, IL-23 inhibitors were associated with a lower risk of paradoxical eczema (hazard ratio [HR], 0.39; 95% CI, 0.19-0.81), and there was no association of IL-17 inhibitors (HR, 1.03; 95% CI, 0.74-1.42) or IL-12\/23 inhibitors (HR, 0.87; 95% CI, 0.66-1.16) with risk of paradoxical eczema. Increasing age (HR, 1.02 per year; 95% CI, 1.01-1.03) and history of AD (HR, 12.40; 95% CI, 6.97-22.06) or hay fever (HR, 3.78; 95% CI, 1.49-9.53) were associated with higher risk of paradoxical eczema. There was a lower risk in males (HR, 0.60; 95% CI, 0.45-0.78).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-doi230059-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this study, in biologic-treated patients with psoriasis, paradoxical eczema risk was lowest in patients receiving IL-23 inhibitors. Increasing age, female sex, and history of AD or hay fever were associated with higher risk of paradoxical eczema. The overall incidence of paradoxical eczema was low. Further study is needed to replicate these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamadermatol.2023.4846","type":"journal-article","created":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T11:03:36Z","timestamp":1701860616000},"page":"71","source":"Crossref","is-referenced-by-count":81,"title":["Risk of Paradoxical Eczema in Patients Receiving Biologics for Psoriasis"],"prefix":"10.1001","volume":"160","author":[{"given":"Ali","family":"Al-Janabi","sequence":"first","affiliation":[{"name":"Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom"},{"name":"Dermatology Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oras A.","family":"Alabas","sequence":"additional","affiliation":[{"name":"Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zenas Z. 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