A LARGE cohort study has found that patients with atopic dermatitis (AD) who are treated with dupilumab face a significantly higher risk of developing psoriasis compared to those treated with other systemic therapies. The study analysed data from 19,720 matched patients, half of whom were prescribed dupilumab, while the others received systemic agents such as corticosteroids, methotrexate, or cyclosporine.
Over a three-year follow-up period, the incidence of psoriasis was 2.86% in the dupilumab group, compared with 1.79% in the control group. This translates to a 58% increased relative risk for those receiving dupilumab, with a hazard ratio of 1.58. The number needed to harm (NNH) was calculated to be 94, meaning that for every 94 patients treated with dupilumab, one additional case of psoriasis may be expected compared with alternative systemic treatments.
Importantly, this association held true across various patient subgroups, including those without common atopic comorbidities and those with low immunoglobulin E levels before treatment. The increased risk was also validated in patients with asthma but without atopic dermatitis, further reinforcing the link between dupilumab and the onset of psoriasis.
While the findings raise concerns, the authors emphasise that the absolute risk increase remains modest. Given dupilumab’s well-documented benefits in controlling moderate to severe AD, clinicians are advised to weigh this potential risk carefully against its therapeutic advantages. The results support the theory that blocking T helper 2 (Th2) pathways with dupilumab may shift the immune balance towards T helper 17 (Th17)-mediated responses, which are implicated in psoriasis development.
Ultimately, while the study suggests a statistically significant association between dupilumab and psoriasis, the clinical impact may be limited. Nonetheless, awareness of this potential adverse effect is important for clinicians monitoring patients on dupilumab, particularly those with personal or family histories of psoriasis.
Reference
Lin TL et al. Psoriasis risk in patients with atopic dermatitis treated with dupilumab. JAMA Dermatol. 2025;DOI:10.1001/jamadermatol.2025.1578.
