Dupilumab Linked to Higher Psoriasis Risk in AD Patients
Key Takeaways
Dupilumab use in adults with atopic dermatitis (AD) is associated with an increased risk of developing psoriasis.
The risk was observed across multiple patient subgroups and validated in a separate asthma cohort.
Despite statistical significance, absolute risk suggests limited clinical impact, according to researchers.
Patients with atopic dermatitis (AD) prescribed dupilumab face a higher risk of developing psoriasis compared to those receiving other systemic agents, according to a large retrospective cohort study in JAMA Dermatology.
Study researchers analyzed data from at more than 214,000 adults with AD in the TriNetX Global Collaborative Network. The analysis included patients newly prescribed dupilumab vs. those started on other systemic therapies without prior dupilumab exposure. The propensity-matched cohorts consisted of 9,860 patients each. The primary study endpoint consisted of incident psoriasis, assessed via Kaplan-Meier and Cox regression analyses.
According to the results, the cumulative incidence of psoriasis was higher in the dupilumab cohort (2.86%) vs. controls (1.79%; P < 0.001). The number needed to harm (NNH) was calculated at 94. Dupilumab was associated with a 58% increased hazard of psoriasis (HR, 1.58; 95% CI, 1.25 to 1.99). This elevated risk persisted across subgroups, including patients without atopic comorbidities (HR, 1.42; 95% CI, 1.06 to 1.89) and those with low baseline IgE levels (HR, 1.59; 95% CI, 1.26 to 2.01). A separate validation cohort of asthma patients without AD showed higher risk (HR, 2.13; 95% CI, 1.38 to 3.31). The risk of psoriatic arthritis did not reach statistical significance (HR, 1.97; 95% CI, 0.75 to 5.18).
The authors, while noting the statistical significance of the results, cautioned as to wider clinical application.
“The results of this cohort study suggest that patients with AD who were prescribed dupilumab exhibited a higher relative risk of developing psoriasis compared with those receiving other systemic agents,” they wrote. “Given an estimated number needed to harm of 94, the absolute risk may have limited clinical relevance and should be weighed against dupilumab’s established efficacy in treating AD.”
Source: Lin TL, et al. JAMA Dermatology. 2025. doi:10.1001/jamadermatol.2025.1578