Pub Date : 2025-01-01DOI: 10.1001/jamadermatol.2024.4445
Robin Reschke, Jasmin Richter, Alexander H Enk, Jessica C Hassel
{"title":"Use of Anti-PD1 Blockade After Hedgehog Inhibitors or as First-Line Therapy for Gorlin Syndrome.","authors":"Robin Reschke, Jasmin Richter, Alexander H Enk, Jessica C Hassel","doi":"10.1001/jamadermatol.2024.4445","DOIUrl":"10.1001/jamadermatol.2024.4445","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"104-105"},"PeriodicalIF":11.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1001/jamadermatol.2024.4433
Axel Svedbom, Lotus Mallbris, Álvaro González-Cantero, Martin Playford, Colin Wu, Nehal N Mehta, Mona Ståhle
Importance: Psoriasis is associated with increased cardiovascular risk, but the underlying pathogenic mechanisms remain unclear. Elucidating these mechanisms can help develop treatment strategies and enhance understanding of the link between peripheral inflammation, such as psoriatic skin lesions, and cardiovascular disease (CVD).
Objective: To explore whether systemic inflammation is a mediator of the association between psoriasis skin disease severity and CVD.
Design, setting, and participants: This cohort study used data from cross-sectional study (Psoriasis Atherosclerosis and Cardiometabolic Disease Initiative [PACI]), which enrolled patients from January 2013 to February 2022, and an inception cohort study (Stockholm Psoriasis Cohort [SPC]), which enrolled patients from January 2000 to December 2005. The PACI enrolled consecutive patients referred by dermatologists in Maryland, and the SPC enrolled consecutive patients referred from a wide range of practices in Sweden. Patients with prevalent psoriasis from the PACI and patients with incident psoriasis from the SPC were included. Data were analyzed from October 2023 to January 2024.
Exposures: Psoriasis skin disease severity was measured using the Psoriasis Area and Severity Index (PASI), and systemic inflammation was measured using glycan biomarker of N-acetyl side chains of acute-phase proteins (GlycA). Mediation analysis was performed by evaluating the associations between exposure, mediator, and outcome in patients with first-tertile and third-tertile PASI scores when GlycA level was set at the level observed in patients with first-tertile PASI.
Main outcomes and measures: Noncalcified coronary burden (NCB) measured using coronary computed tomography angiography in the PACI and hospitalization for CVD or cardiovascular death in the SPC.
Results: Of 260 eligible patients from the PACI, 162 (62.3%) were male, and the median (IQR) age was 51 (41-60) years; of 509 eligible patients from the SPC, 237 (46.6%) were male, and the median (IQR) age was 43 (30-57) years. In both studies, PASI was associated with GlycA level and CVD, and GlycA level was associated with CVD. The direct and indirect (through GlycA) effects of PASI on NCB were estimated at 0.94 (95% CI, 0.26-1.74) and 0.19 (95% CI, 0.02-0.47), respectively. The odds ratios for the direct and indirect effects of PASI on cardiovascular events were estimated at 1.23 (95% CI, 0.70-1.92) and 1.16 (95% CI, 1.04-1.42), respectively.
Conclusions and relevance: In this study, skin disease severity measured using PASI was associated with systemic inflammation, and both PASI and systemic inflammation, measured using GlycA levels, were associated with CVD. The association between PASI and CVD may be mediated by systemic inflammation.
重要性：银屑病与心血管风险增加有关，但其潜在的致病机制仍不清楚。阐明这些机制有助于制定治疗策略，并加深对银屑病皮损等外周炎症与心血管疾病（CVD）之间联系的理解：目的：探讨全身性炎症是否是银屑病皮损严重程度与心血管疾病之间关系的介导因素：这项队列研究使用了横断面研究（银屑病动脉粥样硬化和心脏代谢疾病倡议[PACI]）和起始队列研究（斯德哥尔摩银屑病队列[SPC]）的数据，前者从2013年1月至2022年2月招募患者，后者从2000年1月至2005年12月招募患者。PACI招募的是由马里兰州皮肤科医生转诊的连续患者，SPC招募的是由瑞典各医疗机构转诊的连续患者。PACI 中的银屑病流行期患者和 SPC 中的银屑病发病期患者均被纳入其中。数据分析时间为2023年10月至2024年1月：银屑病皮肤疾病严重程度采用银屑病面积和严重程度指数（PASI）进行测量，全身炎症采用急性期蛋白 N-乙酰侧链的聚糖生物标记物（GlycA）进行测量。当 GlycA 水平设定为 PASI 一档患者所观察到的水平时，通过评估 PASI 一档和三档患者的暴露、中介因子和结果之间的关联进行中介分析：在 PACI 中使用冠状动脉计算机断层扫描血管造影术测量非钙化冠状动脉负担（NCB），在 SPC 中测量心血管疾病住院或心血管疾病死亡：在PACI的260名合格患者中，162人（62.3%）为男性，年龄中位数（IQR）为51（41-60）岁；在SPC的509名合格患者中，237人（46.6%）为男性，年龄中位数（IQR）为43（30-57）岁。在这两项研究中，PASI 与 GlycA 水平和心血管疾病相关，而 GlycA 水平与心血管疾病相关。据估计，PASI 对 NCB 的直接和间接（通过 GlycA）影响分别为 0.94（95% CI，0.26-1.74）和 0.19（95% CI，0.02-0.47）。PASI对心血管事件的直接和间接影响的几率估计分别为1.23（95% CI，0.70-1.92）和1.16（95% CI，1.04-1.42）：在这项研究中，使用 PASI 测量的皮肤病严重程度与全身炎症相关，而使用 GlycA 水平测量的 PASI 和全身炎症与心血管疾病相关。PASI与心血管疾病之间的关联可能是由全身炎症介导的。
{"title":"Skin Inflammation, Systemic Inflammation, and Cardiovascular Disease in Psoriasis.","authors":"Axel Svedbom, Lotus Mallbris, Álvaro González-Cantero, Martin Playford, Colin Wu, Nehal N Mehta, Mona Ståhle","doi":"10.1001/jamadermatol.2024.4433","DOIUrl":"10.1001/jamadermatol.2024.4433","url":null,"abstract":"<p><strong>Importance: </strong>Psoriasis is associated with increased cardiovascular risk, but the underlying pathogenic mechanisms remain unclear. Elucidating these mechanisms can help develop treatment strategies and enhance understanding of the link between peripheral inflammation, such as psoriatic skin lesions, and cardiovascular disease (CVD).</p><p><strong>Objective: </strong>To explore whether systemic inflammation is a mediator of the association between psoriasis skin disease severity and CVD.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from cross-sectional study (Psoriasis Atherosclerosis and Cardiometabolic Disease Initiative [PACI]), which enrolled patients from January 2013 to February 2022, and an inception cohort study (Stockholm Psoriasis Cohort [SPC]), which enrolled patients from January 2000 to December 2005. The PACI enrolled consecutive patients referred by dermatologists in Maryland, and the SPC enrolled consecutive patients referred from a wide range of practices in Sweden. Patients with prevalent psoriasis from the PACI and patients with incident psoriasis from the SPC were included. Data were analyzed from October 2023 to January 2024.</p><p><strong>Exposures: </strong>Psoriasis skin disease severity was measured using the Psoriasis Area and Severity Index (PASI), and systemic inflammation was measured using glycan biomarker of N-acetyl side chains of acute-phase proteins (GlycA). Mediation analysis was performed by evaluating the associations between exposure, mediator, and outcome in patients with first-tertile and third-tertile PASI scores when GlycA level was set at the level observed in patients with first-tertile PASI.</p><p><strong>Main outcomes and measures: </strong>Noncalcified coronary burden (NCB) measured using coronary computed tomography angiography in the PACI and hospitalization for CVD or cardiovascular death in the SPC.</p><p><strong>Results: </strong>Of 260 eligible patients from the PACI, 162 (62.3%) were male, and the median (IQR) age was 51 (41-60) years; of 509 eligible patients from the SPC, 237 (46.6%) were male, and the median (IQR) age was 43 (30-57) years. In both studies, PASI was associated with GlycA level and CVD, and GlycA level was associated with CVD. The direct and indirect (through GlycA) effects of PASI on NCB were estimated at 0.94 (95% CI, 0.26-1.74) and 0.19 (95% CI, 0.02-0.47), respectively. The odds ratios for the direct and indirect effects of PASI on cardiovascular events were estimated at 1.23 (95% CI, 0.70-1.92) and 1.16 (95% CI, 1.04-1.42), respectively.</p><p><strong>Conclusions and relevance: </strong>In this study, skin disease severity measured using PASI was associated with systemic inflammation, and both PASI and systemic inflammation, measured using GlycA levels, were associated with CVD. The association between PASI and CVD may be mediated by systemic inflammation.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"81-86"},"PeriodicalIF":11.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1001/jamadermatol.2024.4688
April W Armstrong, Mark Lebwohl, Richard B Warren, Howard Sofen, Shinichi Imafuku, Mamitaro Ohtsuki, Lynda Spelman, Thierry Passeron, Kim A Papp, Renata M Kisa, John Vaile, Victoria Berger, Eleni Vritzali, Kim Hoyt, Matthew J Colombo, Julie Scotto, Subhashis Banerjee, Bruce Strober, Diamant Thaçi, Andrew Blauvelt
<p><strong>Importance: </strong>Safe and effective long-term treatments for moderate to severe plaque psoriasis are needed.</p><p><strong>Objective: </strong>To evaluate the long-term safety and efficacy of deucravacitinib through 3 years (week 148) in the randomized POETYK PSO-1, PSO-2, and nonrandomized long-term extension (LTE) trials.</p><p><strong>Design, setting, and participants: </strong>PSO-1/PSO-2 were global, 52-week, randomized, double-blinded phase 3 trials in patients with moderate to severe plaque psoriasis. After completing 52 weeks of treatment in PSO-1/PSO-2, patients could enroll in the prespecified, ongoing, nonrandomized LTE trial. The peak of the global COVID-19 pandemic coincided with the LTE trial. Patient enrollment in the LTE started August 12, 2019; safety and efficacy were assessed through June 15, 2022; and these data were analyzed through June 28, 2024.</p><p><strong>Interventions: </strong>The PSO-1/PSO-2 trials randomized patients 1:2:1 to oral placebo, deucravacitinib, 6 mg once daily, or apremilast, 30 mg twice daily. Patients enrolling in the LTE trial received open-label deucravacitinib, 6 mg once daily.</p><p><strong>Main outcomes and measures: </strong>Safety outcomes were evaluated in patients who received 1 or more doses of deucravacitinib. Efficacy outcomes included 75% or greater or 90% or greater reduction from baseline in Psoriasis Area and Severity Index (PASI 75/90) and static Physician Global Assessment scores of 0 (clear) or 1 (almost clear) (sPGA 0/1) and were assessed in patients who received deucravacitinib treatment from day 1 of the parent trials who continued in the LTE trial.</p><p><strong>Results: </strong>Of 1519 patients who received 1 or more doses of deucravacitinib, 513 received continuous deucravacitinib treatment from day 1 and entered the LTE trial. Exposure-adjusted incidence rates (EAIRs) per 100 person-years were decreased or similar in the 1-year vs 3-year cumulative periods, respectively, for adverse events (AEs) (229.2 vs 144.8; 95% CI, 215.4-243.9 vs 137.1-153.0), serious AEs (5.7 vs 5.5; 95% CI, 4.4-7.4 vs 4.7-6.4), discontinuations due to AEs (4.4 vs 2.4; 95% CI, 3.3-5.9 vs 2.0-3.0), and deaths (0.2 vs 0.3; 95% CI, 0.1-0.8 vs 0.2-0.6). Incidence rates of the most common AEs (EAIR per 100 person-years ≥5) during the 1-year and 3-year cumulative periods, respectively, were nasopharyngitis (26.1 vs 11.4; 95% CI, 23.0-29.8 vs 10.2-12.7), COVID-19 (0.5 vs 8.0; 95% CI, 0.2-1.2 vs 7.1-9.1), and upper respiratory tract infection (13.4 vs 6.2; 95% CI, 11.3-16.0 vs 5.4-7.2). EAIRs for AEs of interest, including herpes zoster, major adverse cardiovascular events, and malignant diseases, remained low and were decreased or comparable between the 1-year and 3-year cumulative periods. Clinical response rates were maintained through 3 years.</p><p><strong>Conclusions and relevance: </strong>The findings of this integrated analysis of the phase 3 POETYK PSO-1, PSO-2, and nonrandomized LTE tr
重要性：中重度斑块状银屑病需要安全有效的长期治疗方法：在随机 POETYK PSO-1、PSO-2 和非随机长期扩展（LTE）试验中，评估 deucravacitinib 长达 3 年（第 148 周）的长期安全性和疗效：PSO-1/PSO-2是针对中度至重度斑块状银屑病患者的全球性、为期52周的随机双盲3期试验。在完成PSO-1/PSO-2为期52周的治疗后，患者可参加预设的、正在进行的非随机LTE试验。全球 COVID-19 大流行的高峰期正好与 LTE 试验同时进行。LTE试验的患者注册从2019年8月12日开始；安全性和有效性评估持续到2022年6月15日；这些数据的分析持续到2024年6月28日：PSO-1/PSO-2试验以1:2:1的比例将患者随机分配到口服安慰剂、每天一次每次6毫克的deucravacitinib或每天两次每次30毫克的apremilast。参加LTE试验的患者接受开放标签的德拉瓦替尼治疗，每天一次，每次6毫克：主要结果和指标：对接受1次或1次以上剂量德拉瓦替尼治疗的患者进行安全性评价。疗效结果包括银屑病面积和严重程度指数（PASI 75/90）比基线降低75%或以上或90%或以上，以及静态医生总体评估评分为0（清晰）或1（基本清晰）（sPGA 0/1），评估对象为从母体试验第1天开始接受德拉瓦替尼治疗并继续参加LTE试验的患者：在接受了1次或1次以上剂量德拉瓦替尼治疗的1519名患者中，有513名患者从第1天开始持续接受德拉瓦替尼治疗，并参加了LTE试验。在不良事件（AEs）方面，每百人年暴露调整发病率（EAIRs）在1年和3年的累积期分别下降或相似（229.2 vs 144.8; 95% CI, 215.4-243.9 vs 137.1-153.0）、严重不良事件（5.7 vs 5.5；95% CI，4.4-7.4 vs 4.7-6.4）、不良事件导致的停药（4.4 vs 2.4；95% CI，3.3-5.9 vs 2.0-3.0）和死亡（0.2 vs 0.3；95% CI，0.1-0.8 vs 0.2-0.6）。最常见的 AEs（每百人年 EAIR ≥5）在 1 年和 3 年累计期间的发病率分别为鼻咽炎（26.1 vs 11. 4；95% CI，23.0-3.0）和死亡（0.2 vs 0.3；95% CI，0.1-0.8 vs 0.2-0.6）。4；95% CI，23.0-29.8 vs 10.2-12.7）、COVID-19（0.5 vs 8.0；95% CI，0.2-1.2 vs 7.1-9.1）和上呼吸道感染（13.4 vs 6.2；95% CI，11.3-16.0 vs 5.4-7.2）。包括带状疱疹、主要不良心血管事件和恶性疾病在内的相关 AE 的 EAIR 仍保持在较低水平，且在 1 年和 3 年累积期之间有所下降或不相上下。临床应答率保持了 3 年：这项对 POETYK PSO-1、PSO-2 和非随机 LTE 试验的 3 期综合分析结果表明，银屑病患者持续使用 deucravacitinib 治疗 3 年，具有一致的安全性和持久的临床应答：试验注册：ClinicalTrials.gov Identifiers：NCT03624127、NCT03611751和NCT04036435。
{"title":"Safety and Efficacy of Deucravacitinib in Moderate to Severe Plaque Psoriasis for Up to 3 Years: An Open-Label Extension of Randomized Clinical Trials.","authors":"April W Armstrong, Mark Lebwohl, Richard B Warren, Howard Sofen, Shinichi Imafuku, Mamitaro Ohtsuki, Lynda Spelman, Thierry Passeron, Kim A Papp, Renata M Kisa, John Vaile, Victoria Berger, Eleni Vritzali, Kim Hoyt, Matthew J Colombo, Julie Scotto, Subhashis Banerjee, Bruce Strober, Diamant Thaçi, Andrew Blauvelt","doi":"10.1001/jamadermatol.2024.4688","DOIUrl":"10.1001/jamadermatol.2024.4688","url":null,"abstract":"<p><strong>Importance: </strong>Safe and effective long-term treatments for moderate to severe plaque psoriasis are needed.</p><p><strong>Objective: </strong>To evaluate the long-term safety and efficacy of deucravacitinib through 3 years (week 148) in the randomized POETYK PSO-1, PSO-2, and nonrandomized long-term extension (LTE) trials.</p><p><strong>Design, setting, and participants: </strong>PSO-1/PSO-2 were global, 52-week, randomized, double-blinded phase 3 trials in patients with moderate to severe plaque psoriasis. After completing 52 weeks of treatment in PSO-1/PSO-2, patients could enroll in the prespecified, ongoing, nonrandomized LTE trial. The peak of the global COVID-19 pandemic coincided with the LTE trial. Patient enrollment in the LTE started August 12, 2019; safety and efficacy were assessed through June 15, 2022; and these data were analyzed through June 28, 2024.</p><p><strong>Interventions: </strong>The PSO-1/PSO-2 trials randomized patients 1:2:1 to oral placebo, deucravacitinib, 6 mg once daily, or apremilast, 30 mg twice daily. Patients enrolling in the LTE trial received open-label deucravacitinib, 6 mg once daily.</p><p><strong>Main outcomes and measures: </strong>Safety outcomes were evaluated in patients who received 1 or more doses of deucravacitinib. Efficacy outcomes included 75% or greater or 90% or greater reduction from baseline in Psoriasis Area and Severity Index (PASI 75/90) and static Physician Global Assessment scores of 0 (clear) or 1 (almost clear) (sPGA 0/1) and were assessed in patients who received deucravacitinib treatment from day 1 of the parent trials who continued in the LTE trial.</p><p><strong>Results: </strong>Of 1519 patients who received 1 or more doses of deucravacitinib, 513 received continuous deucravacitinib treatment from day 1 and entered the LTE trial. Exposure-adjusted incidence rates (EAIRs) per 100 person-years were decreased or similar in the 1-year vs 3-year cumulative periods, respectively, for adverse events (AEs) (229.2 vs 144.8; 95% CI, 215.4-243.9 vs 137.1-153.0), serious AEs (5.7 vs 5.5; 95% CI, 4.4-7.4 vs 4.7-6.4), discontinuations due to AEs (4.4 vs 2.4; 95% CI, 3.3-5.9 vs 2.0-3.0), and deaths (0.2 vs 0.3; 95% CI, 0.1-0.8 vs 0.2-0.6). Incidence rates of the most common AEs (EAIR per 100 person-years ≥5) during the 1-year and 3-year cumulative periods, respectively, were nasopharyngitis (26.1 vs 11.4; 95% CI, 23.0-29.8 vs 10.2-12.7), COVID-19 (0.5 vs 8.0; 95% CI, 0.2-1.2 vs 7.1-9.1), and upper respiratory tract infection (13.4 vs 6.2; 95% CI, 11.3-16.0 vs 5.4-7.2). EAIRs for AEs of interest, including herpes zoster, major adverse cardiovascular events, and malignant diseases, remained low and were decreased or comparable between the 1-year and 3-year cumulative periods. Clinical response rates were maintained through 3 years.</p><p><strong>Conclusions and relevance: </strong>The findings of this integrated analysis of the phase 3 POETYK PSO-1, PSO-2, and nonrandomized LTE tr","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"56-66"},"PeriodicalIF":11.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1001/jamadermatol.2024.5178
Amy J McMichael, Cheri Frey
{"title":"Challenging the Tools Used to Measure Cutaneous Lupus Severity in Patients of All Skin Types.","authors":"Amy J McMichael, Cheri Frey","doi":"10.1001/jamadermatol.2024.5178","DOIUrl":"10.1001/jamadermatol.2024.5178","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"9-10"},"PeriodicalIF":11.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1001/jamadermatol.2024.4424
Toan S Bui, Jonathan J Lee
{"title":"Annular Eroded Plaque With Honey-Colored Crusting On Scrotum.","authors":"Toan S Bui, Jonathan J Lee","doi":"10.1001/jamadermatol.2024.4424","DOIUrl":"10.1001/jamadermatol.2024.4424","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"100-101"},"PeriodicalIF":11.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1001/jamadermatol.2024.5073
John S Barbieri, Mya L Roberson
{"title":"Importance of LGBTQ+-Inclusive Language When Developing and Selecting Patient-Reported Outcome Measures.","authors":"John S Barbieri, Mya L Roberson","doi":"10.1001/jamadermatol.2024.5073","DOIUrl":"10.1001/jamadermatol.2024.5073","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"11"},"PeriodicalIF":11.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1001/jamadermatol.2024.4129
Sheng-Yin To, Cho-Hao Lee, Yi-Hsien Chen, Chia-Lu Hsu, Hui-Wen Yang, Ying-Shan Jiang, Yuan-Liang Wen, I-Wen Chen, Li-Ting Kao
Importance: Immune checkpoint inhibitors (ICIs) are recognized as revolutionary cancer therapies but have raised concerns about immune-related adverse events, including the development of autoimmune diseases.
Objective: To evaluate the psoriasis risk associated with the use of ICIs in patients with cancer.
Design, setting, and participants: This nationwide cohort study with a target trial emulation design used data from the Taiwan National Health Insurance database and the Taiwan Cancer Registry. The participants included were patients who received antineoplastic medications for cancer at stages III and IV between January 1, 2019, and June 30, 2021. Data were analyzed from May 2023 to July 2024.
Exposures: Patients treated with ICIs were classified as ICI users, while those who received chemotherapy or targeted therapies were categorized as non-ICI users.
Main outcome and measures: The primary outcome was the incidence of psoriasis during the follow-up period. Stabilized inverse probability of treatment weighting (IPTW) was used to mitigate potential confounders. Cox and Fine-Gray hazard models were used to calculate hazard ratios (HRs) for psoriasis risk between groups.
Results: Of 135 230 patients who received antineoplastic medications (mean [SD] age, 62.94 [13.01] years; 45.1% female), 3188 patients were eligible for the ICI user group, while 132 042 patients were eligible for the non-ICI user group. ICI users experienced a higher incidence of psoriasis at 5.76 cases per 1000 person-years, compared to 1.44 cases in the non-ICI group. After adjusting for demographics and comorbidities, ICI users were found to have a 2-fold increase in the risk of developing psoriasis (IPTW-adjusted HR, 3.31; IPTW-adjusted subdistribution HR, 2.43). Both as-started design and on-treatment design showed consistent findings, and the results were consistent and robust across all follow-up intervals and all sensitivity analyses.
Conclusions and relevance: In this cohort study, patients with cancer treated with ICIs faced an increased risk of psoriasis. Medical professionals should be aware of the potential adverse effects of immunotherapy to ensure optimal cancer care.
{"title":"Psoriasis Risk With Immune Checkpoint Inhibitors.","authors":"Sheng-Yin To, Cho-Hao Lee, Yi-Hsien Chen, Chia-Lu Hsu, Hui-Wen Yang, Ying-Shan Jiang, Yuan-Liang Wen, I-Wen Chen, Li-Ting Kao","doi":"10.1001/jamadermatol.2024.4129","DOIUrl":"10.1001/jamadermatol.2024.4129","url":null,"abstract":"<p><strong>Importance: </strong>Immune checkpoint inhibitors (ICIs) are recognized as revolutionary cancer therapies but have raised concerns about immune-related adverse events, including the development of autoimmune diseases.</p><p><strong>Objective: </strong>To evaluate the psoriasis risk associated with the use of ICIs in patients with cancer.</p><p><strong>Design, setting, and participants: </strong>This nationwide cohort study with a target trial emulation design used data from the Taiwan National Health Insurance database and the Taiwan Cancer Registry. The participants included were patients who received antineoplastic medications for cancer at stages III and IV between January 1, 2019, and June 30, 2021. Data were analyzed from May 2023 to July 2024.</p><p><strong>Exposures: </strong>Patients treated with ICIs were classified as ICI users, while those who received chemotherapy or targeted therapies were categorized as non-ICI users.</p><p><strong>Main outcome and measures: </strong>The primary outcome was the incidence of psoriasis during the follow-up period. Stabilized inverse probability of treatment weighting (IPTW) was used to mitigate potential confounders. Cox and Fine-Gray hazard models were used to calculate hazard ratios (HRs) for psoriasis risk between groups.</p><p><strong>Results: </strong>Of 135 230 patients who received antineoplastic medications (mean [SD] age, 62.94 [13.01] years; 45.1% female), 3188 patients were eligible for the ICI user group, while 132 042 patients were eligible for the non-ICI user group. ICI users experienced a higher incidence of psoriasis at 5.76 cases per 1000 person-years, compared to 1.44 cases in the non-ICI group. After adjusting for demographics and comorbidities, ICI users were found to have a 2-fold increase in the risk of developing psoriasis (IPTW-adjusted HR, 3.31; IPTW-adjusted subdistribution HR, 2.43). Both as-started design and on-treatment design showed consistent findings, and the results were consistent and robust across all follow-up intervals and all sensitivity analyses.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, patients with cancer treated with ICIs faced an increased risk of psoriasis. Medical professionals should be aware of the potential adverse effects of immunotherapy to ensure optimal cancer care.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"31-38"},"PeriodicalIF":11.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1001/jamadermatol.2024.4567
Muhammad H Junejo, Julia L Marcus, Kenneth A Katz
{"title":"Doxycycline Postexposure Prophylaxis (DoxyPEP) for Bacterial STI Prevention.","authors":"Muhammad H Junejo, Julia L Marcus, Kenneth A Katz","doi":"10.1001/jamadermatol.2024.4567","DOIUrl":"10.1001/jamadermatol.2024.4567","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"7-8"},"PeriodicalIF":11.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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