Another trial has added to the movement toward shortening the duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI).

MDedge News

In the MASTER DAPT trial involving patients at high risk for bleeding who had undergone implantation of a biodegradable-polymer sirolimus-eluting stent, switching from DAPT to single antiplatelet therapy at a median of 34 days after PCI was noninferior to the continuation of DAPT treatment for a median duration of 193 days with regard to the incidence of major adverse cardiac or cerebral events, and was associated with a lower incidence of major or clinically relevant bleeding.

The results of the study were presented by Marco Valgimigli, MD, Cardiocentro Ticino Institute, Lugano, Switzerland, on Aug. 28 at the virtual European Society of Cardiology (ESC) Congress 2021. They were simultaneously published online in the New England Journal of Medicine.

“It has been suggested in previous studies that if patients are at high bleeding risk, then they do not seem to derive ischemic benefit from prolonging DAPT, they just get the increased bleeding risk,” Dr. Valgimigli said. “But this has never been prospectively tested until now.”

He pointed out that patients at high bleeding risk are a large group, representing up to 40% of patients undergoing PCI, and the MASTER DAPT trial included “all-comer” high-bleeding-risk patients with no selection based on ischemic risk.

M. Alexander Otto, MDedge News

The trial was very well received by commentators at the ESC Hot Line presentation.

Chair of the session, Roxana Mehran, MD, Icahn School of Medicine at Mount Sinai, New York, described the trial as “practice-changing.”

And Robert Byrne, MD, Mater Private Hospital, Dublin, added: “This is a standout trial. We have become more comfortable with abbreviated DAPT in high-bleeding-risk patients, but definite evidence for this has been lacking until now. This study tells us that just 1 month of DAPT appears to be safe in that there was no increase in ischemic complications and there was a clear reduction in bleeding.”

The MASTER DAPT study involved 4,579 patients at high bleeding risk who had undergone implantation of a biodegradable-polymer sirolimus-eluting coronary stent (Ultimaster, Terumo). Around half the patients had PCI for acute coronary syndrome (ACS) and half had it electively. One month after PCI they were randomly assigned to discontinue DAPT immediately (abbreviated therapy) or to continue it for at least 2 additional months (standard therapy).

The three co-primary outcomes were net adverse clinical events (a composite of death from any cause, myocardial infarction, stroke, or major bleeding), major adverse cardiac or cerebral events (a composite of death from any cause, myocardial infarction, or stroke), and major or clinically relevant nonmajor bleeding, all assessed cumulatively at 335 days. The first two outcomes were assessed for noninferiority in the per-protocol population, and the third outcome for superiority in the intention-to-treat population.

Dual antiplatelet therapy consisted of aspirin plus a P2Y12 inhibitor. The choices of the type of P2Y12 inhibitor for DAPT and the type of monotherapy after the discontinuation of DAPT were at the discretion of the investigator. Clopidogrel was the most popular choice, used as monotherapy in 54% of the patients in the abbreviated-therapy group and as part of DAPT in 79% of patients in the standard-therapy group.

Results showed that net adverse clinical events occurred in 7.5% of the abbreviated-therapy group and in 7.7% of the standard-therapy group (difference, –0.23 percentage points; 95% confidence interval, –1.80 to 1.33 percentage points; P < .001 for noninferiority).

Major adverse cardiac or cerebral events occurred in 6.1% of the abbreviated-therapy group and 5.9% of standard therapy group (difference, 0.11 percentage points; 95% CI, –1.29 to 1.51 percentage points; P = .001 for noninferiority).

Reduction in bleeding driven by BARC-2

Major bleeding or clinically relevant nonmajor bleeding occurred in 6.5% in the abbreviated-therapy group and in 9.4% in the standard-therapy group (difference, –2.82 percentage points; 95% CI, –4.40 to –1.24 percentage points; P < .001 for superiority).

“This is a highly statistically significant reduction in bleeding giving a number needed to treat of 35,” Dr. Valgimigli said.

The lower risk for bleeding in the abbreviated-therapy group was mainly due to the lower incidence of clinically relevant nonmajor bleeding events (BARC type 2) in this group than in the standard-therapy group (4.5% vs. 6.8%).

During the discussion, Dr. Byrne pointed out that the most serious type of bleeding (BARC type 3-5) was not reduced in the abbreviated DAPT group.

Dr. Valgimigli responded that the investigators were surprised about that because previous studies indicated that this most serious bleeding would be reduced, but he suggested that this may be explained by the standard group receiving 3-6 months of DAPT rather than a year or more in previous studies. “Having said that, BARC-2 bleeding is not a trivial event,” he added.
 

Can results be applied to other stents?

Dr. Byrne also questioned whether the results can be applied to patients receiving other types of stents – not just Ultimaster, which is not available everywhere. Dr. Valgimigli highlighted the low rate of stent thrombosis seen with the Ultimaster stent and said, “I would be scared to assume these results are reproducible with other stents.”

But Dr. Mehran challenged this view, saying, “I’m not so sure about that. I think we can probably extrapolate.”

In an interview, Dr. Mehran added: “I think this is one of the much-needed studies in our field. For the first time, we have a randomized trial on duration of DAPT in high-bleeding-risk patients. The study was inclusive, and enrolled truly high-bleeding-risk patients, including those on oral anticoagulants.  

“These results show that, although high-bleeding-risk patients are at high risk of ischemic events, just 1 month of DAPT works well for them regardless, by reducing bleeding, net adverse clinical events, and without increasing ischemic events,” she concluded.

In an editorial accompanying the publication, E. Magnus Ohman, MB, from Duke University, Durham, N.C., pointed out the wide CIs in the results, which he said introduced some uncertainly to the findings.

But he concluded that: “The findings of Dr. Valgimigli and colleagues are important and move us toward a shorter and simpler antithrombotic strategy after PCI.”

In an interview, Dr. Ohman pointed out that the Ultimaster stent is not available in the United States. “We have to think about whether this stent would perform differently to other third- or fourth-generation stents. I wouldn’t have thought so, but it is hard to say for sure.

“All in all, we are looking at shorter periods of DAPT now after PCI. Several trials have now suggested that is the way to go. The forthcoming U.S. PCI guidelines should put all the studies together and come up with recommendations on different patient groups,” he concluded.  

Several commentators said they would like to see the data on the patients receiving oral anticoagulants in the study before making firm conclusions on how to translate the results into clinical practice. “This is such an important group. It is difficult to interpret the results without this data,” Dr. Ohman noted.  Patients receiving oral anticoagulants, who made up 36% of the study population, will be the subject of a separate report to be presented at the ESC meeting.

The MASTER DAPT trial was supported by Terumo. Dr. Valgimigli reports research grants from Terumo, Abbott, and SMT and consulting or speaker fees from Terumo, Abbott, Daiichi Sankyo, Chiesi, Vesalio, Vifor, Avimedica, Medtronic, Boston Scientific, and AstraZeneca. Dr. Ohman reports grants from Abiomed, grants from Chiesi USA, personal fees from Cara Therapeutics, Genentech, Imbria, Impulse Dynamics, Milestone Pharmaceuticals, XyloCor, Cytokinetics, Dispersol, Otsuka, Pfizer, Cytosorbents, Neurocrine, and Paradigm, outside the submitted work.

A version of this article first appeared on Medscape.com.

Another trial has added to the movement toward shortening the duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI).

MDedge News

In the MASTER DAPT trial involving patients at high risk for bleeding who had undergone implantation of a biodegradable-polymer sirolimus-eluting stent, switching from DAPT to single antiplatelet therapy at a median of 34 days after PCI was noninferior to the continuation of DAPT treatment for a median duration of 193 days with regard to the incidence of major adverse cardiac or cerebral events, and was associated with a lower incidence of major or clinically relevant bleeding.

The results of the study were presented by Marco Valgimigli, MD, Cardiocentro Ticino Institute, Lugano, Switzerland, on Aug. 28 at the virtual European Society of Cardiology (ESC) Congress 2021. They were simultaneously published online in the New England Journal of Medicine.

“It has been suggested in previous studies that if patients are at high bleeding risk, then they do not seem to derive ischemic benefit from prolonging DAPT, they just get the increased bleeding risk,” Dr. Valgimigli said. “But this has never been prospectively tested until now.”

He pointed out that patients at high bleeding risk are a large group, representing up to 40% of patients undergoing PCI, and the MASTER DAPT trial included “all-comer” high-bleeding-risk patients with no selection based on ischemic risk.

M. Alexander Otto, MDedge News

The trial was very well received by commentators at the ESC Hot Line presentation.

Chair of the session, Roxana Mehran, MD, Icahn School of Medicine at Mount Sinai, New York, described the trial as “practice-changing.”

And Robert Byrne, MD, Mater Private Hospital, Dublin, added: “This is a standout trial. We have become more comfortable with abbreviated DAPT in high-bleeding-risk patients, but definite evidence for this has been lacking until now. This study tells us that just 1 month of DAPT appears to be safe in that there was no increase in ischemic complications and there was a clear reduction in bleeding.”

The MASTER DAPT study involved 4,579 patients at high bleeding risk who had undergone implantation of a biodegradable-polymer sirolimus-eluting coronary stent (Ultimaster, Terumo). Around half the patients had PCI for acute coronary syndrome (ACS) and half had it electively. One month after PCI they were randomly assigned to discontinue DAPT immediately (abbreviated therapy) or to continue it for at least 2 additional months (standard therapy).

The three co-primary outcomes were net adverse clinical events (a composite of death from any cause, myocardial infarction, stroke, or major bleeding), major adverse cardiac or cerebral events (a composite of death from any cause, myocardial infarction, or stroke), and major or clinically relevant nonmajor bleeding, all assessed cumulatively at 335 days. The first two outcomes were assessed for noninferiority in the per-protocol population, and the third outcome for superiority in the intention-to-treat population.

Dual antiplatelet therapy consisted of aspirin plus a P2Y12 inhibitor. The choices of the type of P2Y12 inhibitor for DAPT and the type of monotherapy after the discontinuation of DAPT were at the discretion of the investigator. Clopidogrel was the most popular choice, used as monotherapy in 54% of the patients in the abbreviated-therapy group and as part of DAPT in 79% of patients in the standard-therapy group.

Results showed that net adverse clinical events occurred in 7.5% of the abbreviated-therapy group and in 7.7% of the standard-therapy group (difference, –0.23 percentage points; 95% confidence interval, –1.80 to 1.33 percentage points; P < .001 for noninferiority).

Major adverse cardiac or cerebral events occurred in 6.1% of the abbreviated-therapy group and 5.9% of standard therapy group (difference, 0.11 percentage points; 95% CI, –1.29 to 1.51 percentage points; P = .001 for noninferiority).

Reduction in bleeding driven by BARC-2

Major bleeding or clinically relevant nonmajor bleeding occurred in 6.5% in the abbreviated-therapy group and in 9.4% in the standard-therapy group (difference, –2.82 percentage points; 95% CI, –4.40 to –1.24 percentage points; P < .001 for superiority).

“This is a highly statistically significant reduction in bleeding giving a number needed to treat of 35,” Dr. Valgimigli said.

The lower risk for bleeding in the abbreviated-therapy group was mainly due to the lower incidence of clinically relevant nonmajor bleeding events (BARC type 2) in this group than in the standard-therapy group (4.5% vs. 6.8%).

During the discussion, Dr. Byrne pointed out that the most serious type of bleeding (BARC type 3-5) was not reduced in the abbreviated DAPT group.

Dr. Valgimigli responded that the investigators were surprised about that because previous studies indicated that this most serious bleeding would be reduced, but he suggested that this may be explained by the standard group receiving 3-6 months of DAPT rather than a year or more in previous studies. “Having said that, BARC-2 bleeding is not a trivial event,” he added.
 

Can results be applied to other stents?

Dr. Byrne also questioned whether the results can be applied to patients receiving other types of stents – not just Ultimaster, which is not available everywhere. Dr. Valgimigli highlighted the low rate of stent thrombosis seen with the Ultimaster stent and said, “I would be scared to assume these results are reproducible with other stents.”

But Dr. Mehran challenged this view, saying, “I’m not so sure about that. I think we can probably extrapolate.”

In an interview, Dr. Mehran added: “I think this is one of the much-needed studies in our field. For the first time, we have a randomized trial on duration of DAPT in high-bleeding-risk patients. The study was inclusive, and enrolled truly high-bleeding-risk patients, including those on oral anticoagulants.  

“These results show that, although high-bleeding-risk patients are at high risk of ischemic events, just 1 month of DAPT works well for them regardless, by reducing bleeding, net adverse clinical events, and without increasing ischemic events,” she concluded.

In an editorial accompanying the publication, E. Magnus Ohman, MB, from Duke University, Durham, N.C., pointed out the wide CIs in the results, which he said introduced some uncertainly to the findings.

But he concluded that: “The findings of Dr. Valgimigli and colleagues are important and move us toward a shorter and simpler antithrombotic strategy after PCI.”

In an interview, Dr. Ohman pointed out that the Ultimaster stent is not available in the United States. “We have to think about whether this stent would perform differently to other third- or fourth-generation stents. I wouldn’t have thought so, but it is hard to say for sure.

“All in all, we are looking at shorter periods of DAPT now after PCI. Several trials have now suggested that is the way to go. The forthcoming U.S. PCI guidelines should put all the studies together and come up with recommendations on different patient groups,” he concluded.  

Several commentators said they would like to see the data on the patients receiving oral anticoagulants in the study before making firm conclusions on how to translate the results into clinical practice. “This is such an important group. It is difficult to interpret the results without this data,” Dr. Ohman noted.  Patients receiving oral anticoagulants, who made up 36% of the study population, will be the subject of a separate report to be presented at the ESC meeting.

The MASTER DAPT trial was supported by Terumo. Dr. Valgimigli reports research grants from Terumo, Abbott, and SMT and consulting or speaker fees from Terumo, Abbott, Daiichi Sankyo, Chiesi, Vesalio, Vifor, Avimedica, Medtronic, Boston Scientific, and AstraZeneca. Dr. Ohman reports grants from Abiomed, grants from Chiesi USA, personal fees from Cara Therapeutics, Genentech, Imbria, Impulse Dynamics, Milestone Pharmaceuticals, XyloCor, Cytokinetics, Dispersol, Otsuka, Pfizer, Cytosorbents, Neurocrine, and Paradigm, outside the submitted work.

A version of this article first appeared on Medscape.com.

Another trial has added to the movement toward shortening the duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI).

MDedge News

In the MASTER DAPT trial involving patients at high risk for bleeding who had undergone implantation of a biodegradable-polymer sirolimus-eluting stent, switching from DAPT to single antiplatelet therapy at a median of 34 days after PCI was noninferior to the continuation of DAPT treatment for a median duration of 193 days with regard to the incidence of major adverse cardiac or cerebral events, and was associated with a lower incidence of major or clinically relevant bleeding.

The results of the study were presented by Marco Valgimigli, MD, Cardiocentro Ticino Institute, Lugano, Switzerland, on Aug. 28 at the virtual European Society of Cardiology (ESC) Congress 2021. They were simultaneously published online in the New England Journal of Medicine.

“It has been suggested in previous studies that if patients are at high bleeding risk, then they do not seem to derive ischemic benefit from prolonging DAPT, they just get the increased bleeding risk,” Dr. Valgimigli said. “But this has never been prospectively tested until now.”

He pointed out that patients at high bleeding risk are a large group, representing up to 40% of patients undergoing PCI, and the MASTER DAPT trial included “all-comer” high-bleeding-risk patients with no selection based on ischemic risk.

M. Alexander Otto, MDedge News

The trial was very well received by commentators at the ESC Hot Line presentation.

Chair of the session, Roxana Mehran, MD, Icahn School of Medicine at Mount Sinai, New York, described the trial as “practice-changing.”

And Robert Byrne, MD, Mater Private Hospital, Dublin, added: “This is a standout trial. We have become more comfortable with abbreviated DAPT in high-bleeding-risk patients, but definite evidence for this has been lacking until now. This study tells us that just 1 month of DAPT appears to be safe in that there was no increase in ischemic complications and there was a clear reduction in bleeding.”

The MASTER DAPT study involved 4,579 patients at high bleeding risk who had undergone implantation of a biodegradable-polymer sirolimus-eluting coronary stent (Ultimaster, Terumo). Around half the patients had PCI for acute coronary syndrome (ACS) and half had it electively. One month after PCI they were randomly assigned to discontinue DAPT immediately (abbreviated therapy) or to continue it for at least 2 additional months (standard therapy).

The three co-primary outcomes were net adverse clinical events (a composite of death from any cause, myocardial infarction, stroke, or major bleeding), major adverse cardiac or cerebral events (a composite of death from any cause, myocardial infarction, or stroke), and major or clinically relevant nonmajor bleeding, all assessed cumulatively at 335 days. The first two outcomes were assessed for noninferiority in the per-protocol population, and the third outcome for superiority in the intention-to-treat population.

Dual antiplatelet therapy consisted of aspirin plus a P2Y12 inhibitor. The choices of the type of P2Y12 inhibitor for DAPT and the type of monotherapy after the discontinuation of DAPT were at the discretion of the investigator. Clopidogrel was the most popular choice, used as monotherapy in 54% of the patients in the abbreviated-therapy group and as part of DAPT in 79% of patients in the standard-therapy group.

Results showed that net adverse clinical events occurred in 7.5% of the abbreviated-therapy group and in 7.7% of the standard-therapy group (difference, –0.23 percentage points; 95% confidence interval, –1.80 to 1.33 percentage points; P < .001 for noninferiority).

Major adverse cardiac or cerebral events occurred in 6.1% of the abbreviated-therapy group and 5.9% of standard therapy group (difference, 0.11 percentage points; 95% CI, –1.29 to 1.51 percentage points; P = .001 for noninferiority).

Reduction in bleeding driven by BARC-2

Major bleeding or clinically relevant nonmajor bleeding occurred in 6.5% in the abbreviated-therapy group and in 9.4% in the standard-therapy group (difference, –2.82 percentage points; 95% CI, –4.40 to –1.24 percentage points; P < .001 for superiority).

“This is a highly statistically significant reduction in bleeding giving a number needed to treat of 35,” Dr. Valgimigli said.

The lower risk for bleeding in the abbreviated-therapy group was mainly due to the lower incidence of clinically relevant nonmajor bleeding events (BARC type 2) in this group than in the standard-therapy group (4.5% vs. 6.8%).

During the discussion, Dr. Byrne pointed out that the most serious type of bleeding (BARC type 3-5) was not reduced in the abbreviated DAPT group.

Dr. Valgimigli responded that the investigators were surprised about that because previous studies indicated that this most serious bleeding would be reduced, but he suggested that this may be explained by the standard group receiving 3-6 months of DAPT rather than a year or more in previous studies. “Having said that, BARC-2 bleeding is not a trivial event,” he added.
 

Can results be applied to other stents?

Dr. Byrne also questioned whether the results can be applied to patients receiving other types of stents – not just Ultimaster, which is not available everywhere. Dr. Valgimigli highlighted the low rate of stent thrombosis seen with the Ultimaster stent and said, “I would be scared to assume these results are reproducible with other stents.”

But Dr. Mehran challenged this view, saying, “I’m not so sure about that. I think we can probably extrapolate.”

In an interview, Dr. Mehran added: “I think this is one of the much-needed studies in our field. For the first time, we have a randomized trial on duration of DAPT in high-bleeding-risk patients. The study was inclusive, and enrolled truly high-bleeding-risk patients, including those on oral anticoagulants.  

“These results show that, although high-bleeding-risk patients are at high risk of ischemic events, just 1 month of DAPT works well for them regardless, by reducing bleeding, net adverse clinical events, and without increasing ischemic events,” she concluded.

In an editorial accompanying the publication, E. Magnus Ohman, MB, from Duke University, Durham, N.C., pointed out the wide CIs in the results, which he said introduced some uncertainly to the findings.

But he concluded that: “The findings of Dr. Valgimigli and colleagues are important and move us toward a shorter and simpler antithrombotic strategy after PCI.”

In an interview, Dr. Ohman pointed out that the Ultimaster stent is not available in the United States. “We have to think about whether this stent would perform differently to other third- or fourth-generation stents. I wouldn’t have thought so, but it is hard to say for sure.

“All in all, we are looking at shorter periods of DAPT now after PCI. Several trials have now suggested that is the way to go. The forthcoming U.S. PCI guidelines should put all the studies together and come up with recommendations on different patient groups,” he concluded.  

Several commentators said they would like to see the data on the patients receiving oral anticoagulants in the study before making firm conclusions on how to translate the results into clinical practice. “This is such an important group. It is difficult to interpret the results without this data,” Dr. Ohman noted.  Patients receiving oral anticoagulants, who made up 36% of the study population, will be the subject of a separate report to be presented at the ESC meeting.

The MASTER DAPT trial was supported by Terumo. Dr. Valgimigli reports research grants from Terumo, Abbott, and SMT and consulting or speaker fees from Terumo, Abbott, Daiichi Sankyo, Chiesi, Vesalio, Vifor, Avimedica, Medtronic, Boston Scientific, and AstraZeneca. Dr. Ohman reports grants from Abiomed, grants from Chiesi USA, personal fees from Cara Therapeutics, Genentech, Imbria, Impulse Dynamics, Milestone Pharmaceuticals, XyloCor, Cytokinetics, Dispersol, Otsuka, Pfizer, Cytosorbents, Neurocrine, and Paradigm, outside the submitted work.

A version of this article first appeared on Medscape.com.

Key clinical point: Although rates of principal psoriasis hospitalizations have decreased among patients with psoriasis in the last 2 decades in the United States, hospitalization for non-psoriatic reasons has increased, which may be attributed to increased comorbidity burden driving admissions because of comorbidities.

Major finding: Between 1998 and 2018, the incidence of hospitalizations with either principal or secondary diagnosis of psoriasis increased from 17.9 to 52.0 per 100,000 persons, the proportion of patients with psoriasis hospitalized with psoriasis as principal diagnosis reduced from 4.1% to 1.0%, and those with Charlson Comorbidity Index score of 3 or higher increased from 13.9% to 30.9% (all adjusted P-trend < .0001).

Study details: This was a 21-year longitudinal trend analysis of the National Inpatient Sample database between 1998 and 2018 including adults with a principal or secondary diagnosis of psoriasis.

Disclosures: The study did not receive any funding. The authors declared no conflict of interests.

Source: Edigin E et al. J Eur Acad Dermatol Venereol. 2021 Aug 9. doi: 10.1111/jdv.17590.

Key clinical point: Although rates of principal psoriasis hospitalizations have decreased among patients with psoriasis in the last 2 decades in the United States, hospitalization for non-psoriatic reasons has increased, which may be attributed to increased comorbidity burden driving admissions because of comorbidities.

Major finding: Between 1998 and 2018, the incidence of hospitalizations with either principal or secondary diagnosis of psoriasis increased from 17.9 to 52.0 per 100,000 persons, the proportion of patients with psoriasis hospitalized with psoriasis as principal diagnosis reduced from 4.1% to 1.0%, and those with Charlson Comorbidity Index score of 3 or higher increased from 13.9% to 30.9% (all adjusted P-trend < .0001).

Study details: This was a 21-year longitudinal trend analysis of the National Inpatient Sample database between 1998 and 2018 including adults with a principal or secondary diagnosis of psoriasis.

Disclosures: The study did not receive any funding. The authors declared no conflict of interests.

Source: Edigin E et al. J Eur Acad Dermatol Venereol. 2021 Aug 9. doi: 10.1111/jdv.17590.

Key clinical point: Although rates of principal psoriasis hospitalizations have decreased among patients with psoriasis in the last 2 decades in the United States, hospitalization for non-psoriatic reasons has increased, which may be attributed to increased comorbidity burden driving admissions because of comorbidities.

Major finding: Between 1998 and 2018, the incidence of hospitalizations with either principal or secondary diagnosis of psoriasis increased from 17.9 to 52.0 per 100,000 persons, the proportion of patients with psoriasis hospitalized with psoriasis as principal diagnosis reduced from 4.1% to 1.0%, and those with Charlson Comorbidity Index score of 3 or higher increased from 13.9% to 30.9% (all adjusted P-trend < .0001).

Study details: This was a 21-year longitudinal trend analysis of the National Inpatient Sample database between 1998 and 2018 including adults with a principal or secondary diagnosis of psoriasis.

Disclosures: The study did not receive any funding. The authors declared no conflict of interests.

Source: Edigin E et al. J Eur Acad Dermatol Venereol. 2021 Aug 9. doi: 10.1111/jdv.17590.

Key clinical point: A significant relation was observed between low hemoglobin levels and increased risk for psoriasis in patients with chronic kidney disease (CKD), indicating that proactive treatment for inflammation might help manage both anemia and psoriasis in patients with CKD.

Major finding: During a mean follow-up period of 6.16±1.02 years, 2.39% of patients with CKD developed psoriasis with cumulative incidence higher in patients with vs without anemia (P less than .0001). The risk for psoriasis was significantly higher in patients with vs without anemia (adjusted hazard ratio, 1.109; P < .0001).

Study details: Findings are from a retrospective cohort study of 576,461 patients with CKD.

Disclosures: This study was supported by a National Research Foundation of Korea grant funded by the Korean government. The authors declare no competing interests.

Source: Lee SH et al. Sci Rep. 2021 Jul 20. doi: 10.1038/s41598-021-94165-w.

Key clinical point: A significant relation was observed between low hemoglobin levels and increased risk for psoriasis in patients with chronic kidney disease (CKD), indicating that proactive treatment for inflammation might help manage both anemia and psoriasis in patients with CKD.

Major finding: During a mean follow-up period of 6.16±1.02 years, 2.39% of patients with CKD developed psoriasis with cumulative incidence higher in patients with vs without anemia (P less than .0001). The risk for psoriasis was significantly higher in patients with vs without anemia (adjusted hazard ratio, 1.109; P < .0001).

Study details: Findings are from a retrospective cohort study of 576,461 patients with CKD.

Disclosures: This study was supported by a National Research Foundation of Korea grant funded by the Korean government. The authors declare no competing interests.

Source: Lee SH et al. Sci Rep. 2021 Jul 20. doi: 10.1038/s41598-021-94165-w.

Key clinical point: A significant relation was observed between low hemoglobin levels and increased risk for psoriasis in patients with chronic kidney disease (CKD), indicating that proactive treatment for inflammation might help manage both anemia and psoriasis in patients with CKD.

Major finding: During a mean follow-up period of 6.16±1.02 years, 2.39% of patients with CKD developed psoriasis with cumulative incidence higher in patients with vs without anemia (P less than .0001). The risk for psoriasis was significantly higher in patients with vs without anemia (adjusted hazard ratio, 1.109; P < .0001).

Study details: Findings are from a retrospective cohort study of 576,461 patients with CKD.

Disclosures: This study was supported by a National Research Foundation of Korea grant funded by the Korean government. The authors declare no competing interests.

Source: Lee SH et al. Sci Rep. 2021 Jul 20. doi: 10.1038/s41598-021-94165-w.

Key clinical point: Long-term proactive management (PM) of psoriasis with calcipotriene 0.005%/betamethasone dipropionate 0.064% (Cal/BD) vs reactive management (RM) benefitted all patients irrespective of baseline characteristics, with greater benefits observed in patients with more severe disease.

Major finding: Effect of treatment on time to first relapse was consistent across all baseline parameters, with treatment group (PM vs RM; hazard ratio [HR], 0.56; P less than .001), baseline Physician Global Assessment (severe vs mild; HR, 2.32; P = .003), and modified Psoriasis Area Severity Index (severe vs mild; HR, 1.77; P = .002) having a significant impact.

Study details: This was a post hoc analysis of phase 3 PSO LONG trial which included a 52-week maintenance phase where patients with psoriasis were randomly assigned to Cal/BD twice weekly (PM) or vehicle foam (RM).

Disclosures: This study was supported by LEO Pharma, Ballerup, Denmark. MG Lebwohl, KA Papp, and RB Warren declared receiving research funds, honoraria for advisory board, speaker, and/or consultant services from various sources including LEO Pharma. MH Mørch and MYJ Bernasconi declared being employees of LEO Pharma.

Source: Lebwohl MG et al. Dermatol Ther (Heidelb). 2021 Aug 2. doi: 10.1007/s13555-021-00585-x.

Key clinical point: Long-term proactive management (PM) of psoriasis with calcipotriene 0.005%/betamethasone dipropionate 0.064% (Cal/BD) vs reactive management (RM) benefitted all patients irrespective of baseline characteristics, with greater benefits observed in patients with more severe disease.

Major finding: Effect of treatment on time to first relapse was consistent across all baseline parameters, with treatment group (PM vs RM; hazard ratio [HR], 0.56; P less than .001), baseline Physician Global Assessment (severe vs mild; HR, 2.32; P = .003), and modified Psoriasis Area Severity Index (severe vs mild; HR, 1.77; P = .002) having a significant impact.

Study details: This was a post hoc analysis of phase 3 PSO LONG trial which included a 52-week maintenance phase where patients with psoriasis were randomly assigned to Cal/BD twice weekly (PM) or vehicle foam (RM).

Disclosures: This study was supported by LEO Pharma, Ballerup, Denmark. MG Lebwohl, KA Papp, and RB Warren declared receiving research funds, honoraria for advisory board, speaker, and/or consultant services from various sources including LEO Pharma. MH Mørch and MYJ Bernasconi declared being employees of LEO Pharma.

Source: Lebwohl MG et al. Dermatol Ther (Heidelb). 2021 Aug 2. doi: 10.1007/s13555-021-00585-x.

Key clinical point: Long-term proactive management (PM) of psoriasis with calcipotriene 0.005%/betamethasone dipropionate 0.064% (Cal/BD) vs reactive management (RM) benefitted all patients irrespective of baseline characteristics, with greater benefits observed in patients with more severe disease.

Major finding: Effect of treatment on time to first relapse was consistent across all baseline parameters, with treatment group (PM vs RM; hazard ratio [HR], 0.56; P less than .001), baseline Physician Global Assessment (severe vs mild; HR, 2.32; P = .003), and modified Psoriasis Area Severity Index (severe vs mild; HR, 1.77; P = .002) having a significant impact.

Study details: This was a post hoc analysis of phase 3 PSO LONG trial which included a 52-week maintenance phase where patients with psoriasis were randomly assigned to Cal/BD twice weekly (PM) or vehicle foam (RM).

Disclosures: This study was supported by LEO Pharma, Ballerup, Denmark. MG Lebwohl, KA Papp, and RB Warren declared receiving research funds, honoraria for advisory board, speaker, and/or consultant services from various sources including LEO Pharma. MH Mørch and MYJ Bernasconi declared being employees of LEO Pharma.

Source: Lebwohl MG et al. Dermatol Ther (Heidelb). 2021 Aug 2. doi: 10.1007/s13555-021-00585-x.

Key clinical point: Dimethyl fumarate may be considered a first-line systemic treatment option to manage psoriasis in the elderly. However, long-term safety, particularly lymphocytopenia, should be closely monitored.

Major finding: The Psoriasis Area and Severity Index score ranged from 3.7 to -24.0 (mean, 9.8±4.1) at week 0, which changed to 4.3±3.2 at week 16 and 2.7±3.2 at week 24 after dimethyl fumarate administration. Overall, 72.8% of adverse events were reported, with the most common being gastrointestinal complaints (29.6%), flushes (12.3%), and lymphocytopenia (12.35%).

Study details: Findings are from a retrospective study including 81 elderly patients with moderate-to-severe psoriasis, aged 65 years and older, treated with dimethyl fumarate for up to 24 weeks.

Disclosures: No source of funding was declared. The authors declared no potential conflict of interests.

Source: Ricceri F et al. J Dermatolo Treat. 2021 Aug 11. doi: 10.1080/09546634.2021.1962000.

Key clinical point: Dimethyl fumarate may be considered a first-line systemic treatment option to manage psoriasis in the elderly. However, long-term safety, particularly lymphocytopenia, should be closely monitored.

Major finding: The Psoriasis Area and Severity Index score ranged from 3.7 to -24.0 (mean, 9.8±4.1) at week 0, which changed to 4.3±3.2 at week 16 and 2.7±3.2 at week 24 after dimethyl fumarate administration. Overall, 72.8% of adverse events were reported, with the most common being gastrointestinal complaints (29.6%), flushes (12.3%), and lymphocytopenia (12.35%).

Study details: Findings are from a retrospective study including 81 elderly patients with moderate-to-severe psoriasis, aged 65 years and older, treated with dimethyl fumarate for up to 24 weeks.

Disclosures: No source of funding was declared. The authors declared no potential conflict of interests.

Source: Ricceri F et al. J Dermatolo Treat. 2021 Aug 11. doi: 10.1080/09546634.2021.1962000.

Key clinical point: Dimethyl fumarate may be considered a first-line systemic treatment option to manage psoriasis in the elderly. However, long-term safety, particularly lymphocytopenia, should be closely monitored.

Major finding: The Psoriasis Area and Severity Index score ranged from 3.7 to -24.0 (mean, 9.8±4.1) at week 0, which changed to 4.3±3.2 at week 16 and 2.7±3.2 at week 24 after dimethyl fumarate administration. Overall, 72.8% of adverse events were reported, with the most common being gastrointestinal complaints (29.6%), flushes (12.3%), and lymphocytopenia (12.35%).

Study details: Findings are from a retrospective study including 81 elderly patients with moderate-to-severe psoriasis, aged 65 years and older, treated with dimethyl fumarate for up to 24 weeks.

Disclosures: No source of funding was declared. The authors declared no potential conflict of interests.

Source: Ricceri F et al. J Dermatolo Treat. 2021 Aug 11. doi: 10.1080/09546634.2021.1962000.

Key clinical point: Among patients with at least mild psoriasis, calcipotriol/betamethasone (Cal/BD) aerosol foam appeared to be beneficial with substantial itch relief and improvement in itch-related sleep loss, itch severity, and quality of life (QoL).

Major finding: The proportion of patients with itch and itch-related sleep loss reduced from 89.3% at baseline to 43.5% at week 4, and 93.4% of patients reported a 30% or more reduction in itch severity. The mean change in Dermatology Life Quality Index score at week 4 was −5.9±4.7, with 76.3% of patients achieving a score of 5 or lesser indicating no/small effect on QoL.

Study details: Findings are from CELSUS, a noninterventional prospective study including 400 patients with plaque psoriasis treated with Cal/BD aerosol foam.

Disclosures: This study was supported by LEO Pharma. Dr. Rigopoulos, Dr. Lazaridou, Dr. Georgiou, Dr. Chasapi, and Dr. Ioannides reported receiving personal fees from various sources including LEO Pharma, outside the submitted work.

Source: Rigopoulos D et al. J Eur Acad Dermatol Venereol. 2021 Aug 9. doi: 10.1111/jdv.17593.

Key clinical point: Among patients with at least mild psoriasis, calcipotriol/betamethasone (Cal/BD) aerosol foam appeared to be beneficial with substantial itch relief and improvement in itch-related sleep loss, itch severity, and quality of life (QoL).

Major finding: The proportion of patients with itch and itch-related sleep loss reduced from 89.3% at baseline to 43.5% at week 4, and 93.4% of patients reported a 30% or more reduction in itch severity. The mean change in Dermatology Life Quality Index score at week 4 was −5.9±4.7, with 76.3% of patients achieving a score of 5 or lesser indicating no/small effect on QoL.

Study details: Findings are from CELSUS, a noninterventional prospective study including 400 patients with plaque psoriasis treated with Cal/BD aerosol foam.

Disclosures: This study was supported by LEO Pharma. Dr. Rigopoulos, Dr. Lazaridou, Dr. Georgiou, Dr. Chasapi, and Dr. Ioannides reported receiving personal fees from various sources including LEO Pharma, outside the submitted work.

Source: Rigopoulos D et al. J Eur Acad Dermatol Venereol. 2021 Aug 9. doi: 10.1111/jdv.17593.

Key clinical point: Among patients with at least mild psoriasis, calcipotriol/betamethasone (Cal/BD) aerosol foam appeared to be beneficial with substantial itch relief and improvement in itch-related sleep loss, itch severity, and quality of life (QoL).

Major finding: The proportion of patients with itch and itch-related sleep loss reduced from 89.3% at baseline to 43.5% at week 4, and 93.4% of patients reported a 30% or more reduction in itch severity. The mean change in Dermatology Life Quality Index score at week 4 was −5.9±4.7, with 76.3% of patients achieving a score of 5 or lesser indicating no/small effect on QoL.

Study details: Findings are from CELSUS, a noninterventional prospective study including 400 patients with plaque psoriasis treated with Cal/BD aerosol foam.

Disclosures: This study was supported by LEO Pharma. Dr. Rigopoulos, Dr. Lazaridou, Dr. Georgiou, Dr. Chasapi, and Dr. Ioannides reported receiving personal fees from various sources including LEO Pharma, outside the submitted work.

Source: Rigopoulos D et al. J Eur Acad Dermatol Venereol. 2021 Aug 9. doi: 10.1111/jdv.17593.

Key clinical point: Prevalence of subclinical atherosclerosis is higher among patients with psoriasis and nonalcoholic fatty liver disease (NAFLD). Additionally, those with elevated hepatic inflammation had a higher burden of coronary atherosclerosis.

Major finding: Among patients with psoriasis, the prevalence of subclinical atherosclerosis was higher among those with vs without NAFLD (61% vs 23%; P = .006). Uptake of 2-[fluorine-18]fluoro-2-deoxy-D-glucose was significantly associated with noncalcified (β, 0.28; P < .001), fibrofatty (β, 0.49; P less than 001), and lipid-rich necrotic core (β, 0.28; P = .003) coronary burden.

Study details: Findings are from a 2-cohort cross-sectional study including 314 patients with psoriasis. The European cohort consisted of 76 patients with psoriasis and 76 control patients and the United States cohort consisted of 162 patients with psoriasis.

Disclosures: This study was funded by National Heart, Lung, and Blood Institute Intramural Research Program. Dr. Mehta, Dr. Gelfand, Dr. González-Cantero, and Dr. Prussick declared serving as a consultant and/or speaker and receiving research grants and personal fees from various sources.

Source: Gonzalez-Cantero A et al. J Invest Dermatol. 2021 Jul 19. doi: 10.1016/j.jid.2021.05.034.

Key clinical point: Prevalence of subclinical atherosclerosis is higher among patients with psoriasis and nonalcoholic fatty liver disease (NAFLD). Additionally, those with elevated hepatic inflammation had a higher burden of coronary atherosclerosis.

Major finding: Among patients with psoriasis, the prevalence of subclinical atherosclerosis was higher among those with vs without NAFLD (61% vs 23%; P = .006). Uptake of 2-[fluorine-18]fluoro-2-deoxy-D-glucose was significantly associated with noncalcified (β, 0.28; P < .001), fibrofatty (β, 0.49; P less than 001), and lipid-rich necrotic core (β, 0.28; P = .003) coronary burden.

Study details: Findings are from a 2-cohort cross-sectional study including 314 patients with psoriasis. The European cohort consisted of 76 patients with psoriasis and 76 control patients and the United States cohort consisted of 162 patients with psoriasis.

Disclosures: This study was funded by National Heart, Lung, and Blood Institute Intramural Research Program. Dr. Mehta, Dr. Gelfand, Dr. González-Cantero, and Dr. Prussick declared serving as a consultant and/or speaker and receiving research grants and personal fees from various sources.

Source: Gonzalez-Cantero A et al. J Invest Dermatol. 2021 Jul 19. doi: 10.1016/j.jid.2021.05.034.

Key clinical point: Prevalence of subclinical atherosclerosis is higher among patients with psoriasis and nonalcoholic fatty liver disease (NAFLD). Additionally, those with elevated hepatic inflammation had a higher burden of coronary atherosclerosis.

Major finding: Among patients with psoriasis, the prevalence of subclinical atherosclerosis was higher among those with vs without NAFLD (61% vs 23%; P = .006). Uptake of 2-[fluorine-18]fluoro-2-deoxy-D-glucose was significantly associated with noncalcified (β, 0.28; P < .001), fibrofatty (β, 0.49; P less than 001), and lipid-rich necrotic core (β, 0.28; P = .003) coronary burden.

Study details: Findings are from a 2-cohort cross-sectional study including 314 patients with psoriasis. The European cohort consisted of 76 patients with psoriasis and 76 control patients and the United States cohort consisted of 162 patients with psoriasis.

Disclosures: This study was funded by National Heart, Lung, and Blood Institute Intramural Research Program. Dr. Mehta, Dr. Gelfand, Dr. González-Cantero, and Dr. Prussick declared serving as a consultant and/or speaker and receiving research grants and personal fees from various sources.

Source: Gonzalez-Cantero A et al. J Invest Dermatol. 2021 Jul 19. doi: 10.1016/j.jid.2021.05.034.

Key clinical point: Compared with the general population, patients with moderate-to-severe plaque psoriasis were at an increased risk for lympho-hematological malignancies (LHM) and lymphoma, particularly cutaneous T-cell lymphoma (CTCL).

Major finding: Patients with moderate-to-severe plaque psoriasis vs general population had significantly higher risk for LHM (hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.24-2.94) and lymphoma (HR, 1.27; 95% CI, 1.08-1.50). The risk for CTCL was markedly augmented in patients with psoriasis (HR, 6.22; 95% CI, 3.39-11.42).

Study details: Findings are from a meta-analysis of 25 observational studies including 2,501,652 study subjects. Most of the studies included patients with moderate-to-severe psoriasis.

Disclosures: The study did not receive any funding. P Gisondi and G Girolomoni declared serving as a consultant and/or speaker for various sources.

Source: Bellinato F et al. J Am Acad Dermatol. 2021 Aug 3. doi: 10.1016/j.jaad.2021.07.050.

Key clinical point: Compared with the general population, patients with moderate-to-severe plaque psoriasis were at an increased risk for lympho-hematological malignancies (LHM) and lymphoma, particularly cutaneous T-cell lymphoma (CTCL).

Major finding: Patients with moderate-to-severe plaque psoriasis vs general population had significantly higher risk for LHM (hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.24-2.94) and lymphoma (HR, 1.27; 95% CI, 1.08-1.50). The risk for CTCL was markedly augmented in patients with psoriasis (HR, 6.22; 95% CI, 3.39-11.42).

Study details: Findings are from a meta-analysis of 25 observational studies including 2,501,652 study subjects. Most of the studies included patients with moderate-to-severe psoriasis.

Disclosures: The study did not receive any funding. P Gisondi and G Girolomoni declared serving as a consultant and/or speaker for various sources.

Source: Bellinato F et al. J Am Acad Dermatol. 2021 Aug 3. doi: 10.1016/j.jaad.2021.07.050.

Key clinical point: Compared with the general population, patients with moderate-to-severe plaque psoriasis were at an increased risk for lympho-hematological malignancies (LHM) and lymphoma, particularly cutaneous T-cell lymphoma (CTCL).

Major finding: Patients with moderate-to-severe plaque psoriasis vs general population had significantly higher risk for LHM (hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.24-2.94) and lymphoma (HR, 1.27; 95% CI, 1.08-1.50). The risk for CTCL was markedly augmented in patients with psoriasis (HR, 6.22; 95% CI, 3.39-11.42).

Study details: Findings are from a meta-analysis of 25 observational studies including 2,501,652 study subjects. Most of the studies included patients with moderate-to-severe psoriasis.

Disclosures: The study did not receive any funding. P Gisondi and G Girolomoni declared serving as a consultant and/or speaker for various sources.

Source: Bellinato F et al. J Am Acad Dermatol. 2021 Aug 3. doi: 10.1016/j.jaad.2021.07.050.

Key clinical point: Use of analgesics was higher in patients with psoriasis, particularly those with concomitant psoriatic arthritis (PsA), which could be because of increased joint pain.

Major finding: Moderate-to-severe joint pain was reported by 69% vs 45% of patients with vs without PsA (P less than .0001). Patients with psoriasis vs reference individuals used more nonsteroidal anti‐inflammatory drugs (NSAIDS; 21.0% vs 17.3%) and opioids (14.2% vs 9.0%) within 1 year. Use of NSAIDS (30.8%) and opioids (22.7%) was even higher in patients with psoriasis and PsA. Of all symptoms, only joint pain seemed to be associated with the use of analgesics (P less than .05).

Study details: Findings are from a cross-sectional study of 4,016 adults with psoriasis including 847 with concomitant PsA and 3,490 reference individuals.

Disclosures: No source of funding was declared. Dr. Loft, Dr. Kristensen, and Dr. Egeberg declared being speakers, receiving fees for speaking and consultancy, and/or research funding from various sources. Dr. Nguyen and Dr. Thyssen declared no potential conflict of interests.

Source: Loft N et al. J Am Acad Dermatol. 2021 Jul 24. doi: 10.1016/j.jaad.2021.07.028.

Key clinical point: Use of analgesics was higher in patients with psoriasis, particularly those with concomitant psoriatic arthritis (PsA), which could be because of increased joint pain.

Major finding: Moderate-to-severe joint pain was reported by 69% vs 45% of patients with vs without PsA (P less than .0001). Patients with psoriasis vs reference individuals used more nonsteroidal anti‐inflammatory drugs (NSAIDS; 21.0% vs 17.3%) and opioids (14.2% vs 9.0%) within 1 year. Use of NSAIDS (30.8%) and opioids (22.7%) was even higher in patients with psoriasis and PsA. Of all symptoms, only joint pain seemed to be associated with the use of analgesics (P less than .05).

Study details: Findings are from a cross-sectional study of 4,016 adults with psoriasis including 847 with concomitant PsA and 3,490 reference individuals.

Disclosures: No source of funding was declared. Dr. Loft, Dr. Kristensen, and Dr. Egeberg declared being speakers, receiving fees for speaking and consultancy, and/or research funding from various sources. Dr. Nguyen and Dr. Thyssen declared no potential conflict of interests.

Source: Loft N et al. J Am Acad Dermatol. 2021 Jul 24. doi: 10.1016/j.jaad.2021.07.028.

Key clinical point: Use of analgesics was higher in patients with psoriasis, particularly those with concomitant psoriatic arthritis (PsA), which could be because of increased joint pain.

Major finding: Moderate-to-severe joint pain was reported by 69% vs 45% of patients with vs without PsA (P less than .0001). Patients with psoriasis vs reference individuals used more nonsteroidal anti‐inflammatory drugs (NSAIDS; 21.0% vs 17.3%) and opioids (14.2% vs 9.0%) within 1 year. Use of NSAIDS (30.8%) and opioids (22.7%) was even higher in patients with psoriasis and PsA. Of all symptoms, only joint pain seemed to be associated with the use of analgesics (P less than .05).

Study details: Findings are from a cross-sectional study of 4,016 adults with psoriasis including 847 with concomitant PsA and 3,490 reference individuals.

Disclosures: No source of funding was declared. Dr. Loft, Dr. Kristensen, and Dr. Egeberg declared being speakers, receiving fees for speaking and consultancy, and/or research funding from various sources. Dr. Nguyen and Dr. Thyssen declared no potential conflict of interests.

Source: Loft N et al. J Am Acad Dermatol. 2021 Jul 24. doi: 10.1016/j.jaad.2021.07.028.

Key clinical point: Patients with moderate-to-severe psoriasis who were new users of infliximab and adalimumab vs etanercept had a higher risk for serious infections. The risk was lower with ustekinumab and comparable with secukinumab, ixekizumab, brodalumab, guselkumab, or apremilast vs etanercept.

Major finding: Compared with etanercept, the risk for serious infections was higher for patients who initiated adalimumab (estimated weighted hazard ratio [wHR], 1.22; 95% confidence interval [CI], 1.07-1.38) or infliximab (wHR, 1.79; 95% CI, 1.49-2.16), whereas the risk was lower with ustekinumab (wHR, 0.79; 95% CI, 0.67-0.94). The risk for serious infections was not higher for new users of secukinumab, ixekizumab, brodalumab, guselkumab, or apremilast vs etanercept.

Study details: Findings are from the analysis of a real-world cohort of 44,239 adults with psoriasis who were new users of biologic/biosimilar or targeted synthetic antipsoriatic agents and had no history of serious infection.

Disclosures: The authors did not report any source of funding. No conflict of interests was reported.

Source: Penso L et al. JAMA Dermatol. 2021 Jul 21. doi: 10.1001/jamadermatol.2021.2599.

Key clinical point: Patients with moderate-to-severe psoriasis who were new users of infliximab and adalimumab vs etanercept had a higher risk for serious infections. The risk was lower with ustekinumab and comparable with secukinumab, ixekizumab, brodalumab, guselkumab, or apremilast vs etanercept.

Major finding: Compared with etanercept, the risk for serious infections was higher for patients who initiated adalimumab (estimated weighted hazard ratio [wHR], 1.22; 95% confidence interval [CI], 1.07-1.38) or infliximab (wHR, 1.79; 95% CI, 1.49-2.16), whereas the risk was lower with ustekinumab (wHR, 0.79; 95% CI, 0.67-0.94). The risk for serious infections was not higher for new users of secukinumab, ixekizumab, brodalumab, guselkumab, or apremilast vs etanercept.

Study details: Findings are from the analysis of a real-world cohort of 44,239 adults with psoriasis who were new users of biologic/biosimilar or targeted synthetic antipsoriatic agents and had no history of serious infection.

Disclosures: The authors did not report any source of funding. No conflict of interests was reported.

Source: Penso L et al. JAMA Dermatol. 2021 Jul 21. doi: 10.1001/jamadermatol.2021.2599.

Key clinical point: Patients with moderate-to-severe psoriasis who were new users of infliximab and adalimumab vs etanercept had a higher risk for serious infections. The risk was lower with ustekinumab and comparable with secukinumab, ixekizumab, brodalumab, guselkumab, or apremilast vs etanercept.

Major finding: Compared with etanercept, the risk for serious infections was higher for patients who initiated adalimumab (estimated weighted hazard ratio [wHR], 1.22; 95% confidence interval [CI], 1.07-1.38) or infliximab (wHR, 1.79; 95% CI, 1.49-2.16), whereas the risk was lower with ustekinumab (wHR, 0.79; 95% CI, 0.67-0.94). The risk for serious infections was not higher for new users of secukinumab, ixekizumab, brodalumab, guselkumab, or apremilast vs etanercept.

Study details: Findings are from the analysis of a real-world cohort of 44,239 adults with psoriasis who were new users of biologic/biosimilar or targeted synthetic antipsoriatic agents and had no history of serious infection.

Disclosures: The authors did not report any source of funding. No conflict of interests was reported.

Source: Penso L et al. JAMA Dermatol. 2021 Jul 21. doi: 10.1001/jamadermatol.2021.2599.