Comparative safety of systemic immunomodulatory medications in adults with atopic dermatitis
| Autor: | Joseph F. Merola, Lourdes M. Perez-Chada, Maria C. Schneeweiss |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Population Azathioprine Dermatology Opportunistic Infections Risk Assessment Severity of Illness Index Dermatitis Atopic Cohort Studies 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Prednisone Internal medicine Epidemiology medicine Humans Immunologic Factors education Aged education.field_of_study business.industry Incidence Incidence (epidemiology) Bacterial Infections Atopic dermatitis Middle Aged medicine.disease Dupilumab 030220 oncology & carcinogenesis Relative risk Female business medicine.drug |
| Zdroj: | Journal of the American Academy of Dermatology. 85:321-329 |
| ISSN: | 0190-9622 |
| Popis: | Background Severe atopic dermatitis (AD) is increasingly treated with systemic immunomodulatory drugs, yet their safety is unclear. Objective We evaluated the comparative risk of serious bacterial and opportunistic infections among patients with severe AD using systemic immunomodulatory medications 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 by using International Classification of Disease diagnosis codes. Relative risks (RRs) were computed after 1-to-1 propensity score matching. Results Up to 232,611 patients with AD were eligible. The incidence of serious infections was 7.53 (7.18-7.89) risk per 1,000 patients among systemic nonbiologic–treated patients, 7.38 (5.68-9.57) risk per 1,000 patients among phototherapy-treated patients, and 2.6 (0.45-14.3) risk per 1,000 patients among dupilumab users. After matching, cyclosporine had a significantly reduced 6-month risk (RR 0.87) and prednisone (RR 1.78), azathioprine (RR 1.89), and mycophenolate (RR 3.31) showed increased risks compared with methotrexate. A small number of dupilumab users showed no increased risk (RR 0.33, 95% confidence interval 0.03-3.20). Limitations Some comparisons involved small population sizes. 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. |
| Databáze: | OpenAIRE |
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