{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:35:53Z","timestamp":1791588953243,"version":"4.3.4"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec id=\"ab-dbr250011-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>The long-term effectiveness of biologic therapies in psoriasis may decline over time. Gut microbiota alterations induced by antibiotics have been proposed as a potential mechanism impairing biologic persistence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-dbr250011-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the association between antibiotic exposure and the persistence of biologic therapies in patients with psoriasis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-dbr250011-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This retrospective cohort study used data from the French National Health Insurance database between June 2011 and December 2022. Adults initiating a biologic therapy for psoriasis were included, excluding those with preexisting inflammatory bowel disease at baseline. Data were analyzed from January to September 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-dbr250011-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>At baseline, antibiotics exposure was classified as none, 1, or 2 or more dispensations in the 6 months preceding the index date. During follow-up, time-dependent antibiotics exposure was defined as none, 1, or 2 or more antibiotics dispensations in the 6 months prior to each time of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-dbr250011-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The primary outcome was discontinuation or switch of the initial biologic therapy. Exposure to antibiotics was assessed within 6 months prior to biologic initiation and during follow-up. A weighted Cox marginal structural model was used to estimate adjusted hazard ratios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-dbr250011-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 36\u202f129 included patients, 11 228 (42.0%) were female, 20\u202f192 (55.9%) were male, and the mean (SD) age was 48.4 (15.1) years. A total of 9366 (25.9%) were exposed to antibiotics at baseline and 21\u202f900 (60.6%) during follow-up. The most commonly prescribed antibiotic classes were \u03b2-lactams, macrolides, and fluoroquinolones. Antibiotic exposure was associated with a higher risk of biologic discontinuation (weighted hazard ratio, 1.12; 95% CI, 1.08-1.16), with a stronger effect observed for multiple dispensations (weighted hazard ratio, 1.29; 95% CI, 1.24-1.35), suggesting a dose-response relationship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-dbr250011-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cohort study, antibiotic exposure was significantly associated with an increased risk of discontinuation of biologic therapies in psoriasis. These findings support the hypothesis that antibiotics, potentially through gut dysbiosis, may reduce biologic persistence. However, unmeasured confounders limit causal interpretation. Further studies are necessary to validate these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamadermatol.2025.4427","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T16:00:39Z","timestamp":1762963239000},"page":"55","source":"Crossref","is-referenced-by-count":3,"title":["Antibiotic Use and the Persistence of Biologic Therapies in Patients With Psoriasis"],"prefix":"10.1001","volume":"162","author":[{"given":"Rapha\u00ebl","family":"Ouakrat","sequence":"first","affiliation":[{"name":"Epidemiology in Dermatology and Evaluation of Therapeutics, EA7379, Paris-Est University, Universit\u00e9 Paris-Est Cr\u00e9teil (UPEC), Cr\u00e9teil, France"},{"name":"D\u00e9partement de Dermatologie, H\u00f4pital Henri Mondor, Assistance Publique-H\u00f4pitaux de Paris, UPEC, Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laetitia","family":"Penso","sequence":"additional","affiliation":[{"name":"Epidemiology in Dermatology and Evaluation of Therapeutics, EA7379, Paris-Est University, Universit\u00e9 Paris-Est Cr\u00e9teil (UPEC), Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Jullien","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Edouard Herriot Hospital, University Hospital of Lyon, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Sokol","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, INSERM UMRS-938, Centre de Recherche Saint-Antoine, CRSA, AP-HP, H\u00f4pital Saint-Antoine, Service de Gastroent\u00e9rologie, Paris, France"},{"name":"Gut, Liver & Microbiome Research (GLIMMER) FHU, Paris, France"},{"name":"INRAE, UMR1319 Micalis, AgroParisTech, Jouy-en-Josas, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Sbidian","sequence":"additional","affiliation":[{"name":"Epidemiology in Dermatology and Evaluation of Therapeutics, EA7379, Paris-Est University, Universit\u00e9 Paris-Est Cr\u00e9teil (UPEC), Cr\u00e9teil, France"},{"name":"D\u00e9partement de Dermatologie, H\u00f4pital Henri Mondor, Assistance Publique-H\u00f4pitaux de Paris, UPEC, Cr\u00e9teil, France"},{"name":"INSERM, Centre d\u2019investigation clinique 1430, H\u00f4pital Henri Mondor, Creteil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"10281","key":"dbr250011r1","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1016\/S0140-6736(20)32549-6","article-title":"Psoriasis.","volume":"397","author":"Griffiths","year":"2021","journal-title":"Lancet"},{"issue":"5","key":"dbr250011r2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011535.pub5","article-title":"Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.","volume":"5","author":"Sbidian","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"dbr250011r3","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1001\/jamadermatol.2022.0364","article-title":"Long-term persistence of first-line biologics for patients with psoriasis and psoriatic arthritis in the French health insurance database.","volume":"158","author":"Pina Vegas","year":"2022","journal-title":"JAMA Dermatol"},{"key":"dbr250011r4","doi-asserted-by":"publisher","first-page":"2491","DOI":"10.2147\/DDDT.S200147","article-title":"Infliximab and biosimilar infliximab in psoriasis: efficacy, loss of efficacy, and adverse events.","volume":"13","author":"Subedi","year":"2019","journal-title":"Drug Des Dev Ther"},{"issue":"3","key":"dbr250011r5","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1111\/bjd.17738","article-title":"Factors predicting persistence of biologic drugs in psoriasis: a systematic review and meta-analysis.","volume":"181","author":"Mourad","year":"2019","journal-title":"Br J Dermatol"},{"issue":"2","key":"dbr250011r6","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1136\/gutjnl-2021-325185","article-title":"Antibiotic use differentially affects the risk of anti-drug antibody formation during anti-TNFa therapy in inflammatory bowel disease patients: a report from the epi-IIRN.","volume":"71","author":"Gorelik","year":"2022","journal-title":"Gut"},{"issue":"12","key":"dbr250011r7","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1007\/s40261-019-00849-7","article-title":"Gut microbiome in psoriasis is perturbed differently during secukinumab and ustekinumab therapy and associated with response to treatment.","volume":"39","author":"Yeh","year":"2019","journal-title":"Clin Drug 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