Which systemic drug is safest for atopic dermatitis patients?

Among systemic immunomodulatory drugs, cyclosporine and methotrexate demonstrate the lowest risks of serious infections at 6 months in adults with atopic dermatitis (AD), suggests a study. On the other hand, prednisone, azathioprine, and mycophenolate are associated with increased risks when compared with methotrexate.

The authors assessed the comparative risk of serious bacterial and opportunistic infections among patients with severe AD using systemic immunomodulatory medications in routine care in this population-based claims data study.

They computed the incidence of serious bacterial and opportunistic infections leading to hospitalization using International Classification of Disease diagnosis codes. Relative risks (RRs) were then computed following 1:1 propensity score matching.

A total of 232,611 patients with AD met the eligibility criteria. The incidence of serious infections stood at 7.53 (7.18–7.89) risk per 1,000 patients among systemic nonbiologics users, 7.38 (5.68–9.57) risk per 1,000 patients among those treated with phototherapy, and 2.6 (0.45–14.3) risk per 1,000 patients among dupilumab users.

After matching, cyclosporine showed a significantly lower 6-month risk (RR, 0.87) while prednisone (RR, 1.78), azathioprine (RR, 1.89), and mycophenolate (RR, 3.31) exhibited increased risks compared with methotrexate. In addition, no increased risk was seen in a small proportion of dupilumab users (RR, 0.33, 95 percent confidence interval, 0.03–3.20).

The study was limited by some comparisons that involved small population sizes, according to the authors.