Dupilumab used for atopic dermatitis Linked to Increased Risk of Psoriasis: JAMA

A new study published in the Journal of American Medical Association showed that dupilumab (Dupixent), used for treating atopic dermatitis, is associated with a higher risk of developing psoriasis compared to other systemic therapies. This link was further validated in asthma patients without atopic dermatitis, suggesting that dupilumab may act as a trigger for psoriasis development.

There have been reports of psoriasis developing in patients with atopic dermatitis (AD) while using dupilumab. It is uncertain if this is an actual relationship or a coincidental occurrence. Thus, this study examined the risk of psoriasis in AD patients receiving dupilumab vs other systemic medications.

In this population-based retrospective cohort analysis, which included 214,430 adult AD patients from the TriNetX Global Collaborative Network and had a 3-year follow-up, the analyses were finished on October 19, 2024. Included were those who had recently been taken dupilumab (dupilumab cohort) and those who had recently been prescribed other systemic medicines but had not been exposed to dupilumab (control group). Age, sex, race, comorbidities, test results, and previous drug use were used to match propensity scores at a 1:1 ratio.

This study's main exposure was to dupilumab in comparison to other systemic drugs, such as methotrexate, cyclosporine, corticosteroids, azathioprine, or mycophenolate mofetil. Incident psoriasis was the main result. Kaplan-Meier plots were used to evaluate cumulative incidence, and Cox regression was used to evaluate hazards.

Each cohort included 9860 patients after matching, with 10891 women (55.2%), a mean (SD) age of 44.8 (20.3) years, 3582 Black or African American people (18.2%), 2004 Asian people (10.2%), and 9901 white people (50.2%).

The dupilumab cohort had a greater 3-year cumulative psoriasis incidence than the control group (2.86% vs. 1.79%; P<.001). When comparing dupilumab to the other systemic medications, the number required to cause damage for psoriasis was 94. Psoriasis risk was higher in the dupilumab cohort (hazard ratio [HR], 1.58; 95% CI, 1.25-1.99), while psoriatic arthritis risk was not statistically significant (HR, 1.97; 95% CI, 0.75-5.18).

Additionally, this elevated risk was noted in AD subgroups with pretreatment immunoglobulin E levels below 0.048 mg/dL (to convert to mg/L, multiply by 10; HR, 1.59; 95% CI, 1.26-2.01) or without atopic comorbidities (HR, 1.42; 95% CI, 1.06-1.89). Validation in individuals with asthma who did not have AD further validated the link between dupilumab and psoriasis (HR, 2.13; 95% CI, 1.38-3.31).

Overall, the findings of this cohort analysis indicate that, in comparison to patients receiving other systemic medications, individuals with AD who were taken dupilumab had a greater relative risk of acquiring psoriasis. The demonstrated effectiveness of dupilumab in treating AD should be considered when evaluating the absolute risk, which may have limited clinical significance given an estimated number needed to damage of 94.

Source:

Lin, T.-L., Fan, Y.-H., Fan, K.-S., Juan, C.-K., Chen, Y.-J., & Wu, C.-Y. (2025). Psoriasis risk in patients with atopic dermatitis treated with dupilumab. JAMA Dermatology (Chicago, Ill.). https://doi.org/10.1001/jamadermatol.2025.1578