TOPLINE:
Janus kinase (JAK) inhibitors were associated with more infections, particularly herpes infections, in patients with atopic dermatitis (AD) compared with biologics, in a cohort study.
METHODOLOGY:
- A prospective, multicenter observational study included 1793 patients (age, ≥ 12 years) with moderate to severe AD from the Dutch BioDay registry between October 2017 and July 2024.
- The patients received biologics (dupilumab and tralokinumab) or a JAK inhibitor (abrocitinib, baricitinib, and upadacitinib).
- The researchers monitored treatment-emergent infections.
TAKEAWAY:
- A total of 512 patients experienced 794 infections (incidence rate, 19.6/100 patient-years). Most were mild (30.6%) or moderate (62.5%).
- JAK inhibitors were associated with higher infection rates (58.4-65.5/100 patient-years) than with biologics (13.6-22.0/100 patient-years). Herpes infections were more frequent with JAK inhibitors (13.6-19.8/100 patient-years) compared with biologics (3.0-3.6/100 patient-years).
- Compared with dupilumab, the risks for infection were higher for abrocitinib (adjusted hazard ratio [HR], 4.1; P < .0001), baricitinib (HR, 4.2; P < .0001), and upadacitinib (HR, 4.0; P < .0001).
- A history of viral (HR, 1.9; P < .0001) or fungal (HR, 2.4; P = .003) skin infections was also associated with infection risk during treatment.
IN PRACTICE:
“This real-world study identified a differential infection risk profile associated with biologic and JAKi [JAK inhibitor] treatment in adults and adolescents with moderate to severe AD, with JAKi showing an elevated risk of both overall, skin and extracutaneous infections compared to biologics,” the authors wrote. These findings, they added, “provide more insight and new perspectives regarding the incidence and burden of infections in AD patients in daily practice and can contribute to tailored treatment choices.”
SOURCE:
This study was led by Lian F. van der Gang, Department of Dermatology and Allergology, University Medical Center Utrecht in Utrecht, the Netherlands. It was published online on April 3 in the Journal of the European Academy of Dermatology and Venereology.
LIMITATIONS:
Study limitations included potential residual confounding from unmeasured variables and shorter follow-up periods for newer treatments. Small sample sizes limited dose-dependent risk analysis, and vaccination status, including for varicella-zoster, was not recorded.
DISCLOSURES:
This study’s funding source was not disclosed. Van der Gang reported receiving speaker fees from AbbVie and Sanofi. Several authors reported receiving consulting, advisory, and speaker fees from various pharmaceutical companies, including Eli Lilly and Company, Leo Pharma, and Pfizer.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.