IL-17A Inhibitors May Cause Atopic-Like Dermatitis in Some Patients With Psoriasis

Elevated immunoglobulin E (IgE) levels and a personal history of atopic disease were found to be independent risk factors for interleukin-17A (IL-17A) inhibitor-induced atopic-like dermatitis, according to study results published in the Journal of the European Academy of Dermatology and Venereology.

Although IL-17A inhibitors have become important in the treatment of psoriasis, atopic-like dermatitis is gaining recognition as a common side-effect of the therapy. Therefore, researchers aimed to determine the prevalence, associated risk factors, outcomes, and management of atopic-like dermatitis in patients with psoriasis treated with IL-17A inhibitors.

Researchers conducted a retrospective study between July 2020 and July 2022 at a single center in China. A total of 226 patients with mild to severe psoriasis with or without psoriatic arthritis were included. Patients’ mean (SD) age was 45.45 (15.49) years and 70% were women. t Approximately 83% of patients had been treated with secukinumab and 17% had been treated with ixekizumab. The median duration of treatment with IL-17A inhibitors was 41 weeks.

Additional data collected by the researchers included severity of atopic dermatitis; eczema and severity index (EASI) and numerical rating scale (NRS); severity of psoriasis at atopic-like dermatitis onset (psoriasis area and severity index [PASI]); affected body surface area (BSA); dermatology life quality index (DLQI); personal and family history of atopic diseases, and laboratory indices, including eosinophil levels and IgE levels. The researchers also recorded potential confounding environmental factors, including smoking habits, drug allergy history, and pet ownership history.

All patients with atopic-like dermatitis were evaluated by 3 dermatologists for agreement, with dermoscopy used as needed. A Naranjo score of 4 or higher indicated that the atopic-like dermatitis was related to treatment with IL-17A inhibitors. Treatment and outcomes of atopic-like dermatitis were recorded.

In the psoriasis cohort, 14 patients (approximately 6%) developed atopic-like dermatitis. In this group, 28.6% were women and the mean BMI was 23.93 kg/m². A total of 12 patients (approximately 86%) reported treatment with secukinumab, and 2 patients (14%) reported treatment with ixekizumab. Twelve patients (86%) had a personal history of atopic diseases such as asthma or atopic rhinitis; 1 patient (7%) had asthma and atopic rhinitis; and 2 patients (14%) had a family history of atopic disease. Six of the 14 patients (approximately 43%) were current or past smokers. There were 5 patients (36%) with a history of pet ownership, and 1 patient (7%) with a history of penicillin allergy. Among the 14 patients, 9 (approximately 64%) had elevated IgE levels, and 1 patient (7%) had blood hypereosinophilia.

Using a logistic regression model, the researchers determined that a personal history of atopic disease (odds ratio [OR], 27.830; 95% CI, 3.801-203.770; P =.001) and an elevated IgE level (OR, 5.867, 95% CI, 1.131-30.434; P =.035) before IL-17A inhibitor initiation were independent risk factors for the development of atopic-like dermatitis. Other variables (age, sex, BMI, type of IL-17A inhibitor used in treatment, pet ownership history, family history of atopic disease, PASI, BSA, DLQI, previous systemic therapy, smoking history, history of drug allergy, and elevated blood eosinophilia) were not statistically significant predictors of atopic-like dermatitis.

Median time between the first injection of IL-17A inhibitor and the appearance of atopic-like dermatitis was approximately 26 weeks (range, 3.0 to 69.7 weeks).

Thirteen of the 14 patients with atopic-like dermatitis continued treatment with the IL-17A inhibitor; 6 were managed solely with topical steroids, 2 received antihistamines alone, and 5 were managed with both topical steroids and antihistamines. Only 1 patient, who experienced severe atopic-like dermatitis, discontinued the IL-17A inhibitor and was switched to tofacitinib; atopic-like dermatitis and psoriasis improved without recurrence.

Study limitations include the fact that the researchers diagnosed atopic-like dermatitis based only on skin lesion characteristics, without histologic confirmation. Further studies with larger sample sizes are needed.

The researchers concluded, ” Prior to treatment, [patients with psoriasis] who have the risk factors for ALD should be informed of the possible development of ALD, and alternative psoriatic therapeutic options should be considered if severe ALD develops.” They noted, “After ALD develops, it is crucial to balance the risks and benefits of continuing the original drug. Personalized strategies are recommended according to the severity of ALD and psoriasis, and a prudent evaluation of the effect of skin lesions on the quality of life is important.”

This article originally appeared on Dermatology Advisor