Journal of Cosmetic Dermatology

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A New Hope for Melasma: Long-Term Clearance With 755-nm Picosecond Alexandrite Laser and Topical JAK Inhibition.

A New Hope for Melasma: Long‐Term Clearance With 755‐nm Picosecond Alexandrite Laser and Topical JAK Inhibition

JAMA Dermatology

<jats:sec id="ab-doi250005-4"><jats:title>Importance</jats:title><jats:p>Systemic treatments for psoriatic disease affect the immune system and may increase infection risk. Older adults are at high risk for infection, and the relative safety of systemic treatments for them is unknown.</jats:p></jats:sec><jats:sec id="ab-doi250005-5"><jats:title>Objective</jats:title><jats:p>To evaluate the association of systemic treatments for psoriatic disease with rates of serious infection among older adults.</jats:p></jats:sec><jats:sec id="ab-doi250005-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This cohort study used linked population-based health administrative data from 2002 to 2021 in Ontario, Canada. Participants included Ontario residents 66 years and older with psoriatic disease who were dispensed their first systemic medication between April 1, 2002, and December 31, 2020. Data were analyzed between November 2021 and August 2024.</jats:p></jats:sec><jats:sec id="ab-doi250005-7"><jats:title>Exposure</jats:title><jats:p>Time-varying use of systemic medications categorized as (1) methotrexate; (2) other older systemic medications; (3) anti–tumor necrosis factor (anti-TNF) biologics; (4) other biologics (targeting interleukin [IL]-12, IL-23, and IL-17); and (5) tofacitinib.</jats:p></jats:sec><jats:sec id="ab-doi250005-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>The main outcome was time to serious infection, defined as hospitalization for any infectious cause occurring up to March 2021. Multivariable Andersen-Gill recurrent event regression was used to estimate the association between each medication category and serious infection rates. The relative rates (RRs) of serious infection with 95% CIs for time actively using each medication category vs time not using that medication category were calculated.</jats:p></jats:sec><jats:sec id="ab-doi250005-9"><jats:title>Results</jats:title><jats:p>Of 11 641 new users of systemic therapy, 6114 (53%) were female, and the median (IQR) age was 71 (68-76) years. There were 1967 serious infections during a median (IQR) of 4.8 (2.3-8.4) years of follow-up. There were 2.7 serious infections per 100 person-years using methotrexate, 2.5 per 100 person-years using other older systemic drugs, 2.2 per 100 person-years using anti-TNF biologics, 1.4 per 100 person-years using other biologics, and 8.9 per 100 person-years using tofacitinib. In the multivariable-adjusted model, methotrexate (RR, 0.95 [95% CI, 0.85-1.07]), other older systemic medications (RR, 0.92 [95% CI, 0.79-1.07]), and anti-TNF biologics (RR, 0.87 [95% CI, 0.69-1.10]) were not associated with serious infection compared to person-time not using those respective medications. Other biologics (RR, 0.65 [95% CI, 0.48-0.88]) were associated with lower rates of serious infection, whereas tofacitinib (RR, 2.89 [95% CI, 1.14-7.34]) was associated with higher rates of serious infection.</jats:p></jats:sec><jats:sec id="ab-doi250005-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>In this cohort study, biologics targeting IL-12, IL-23, or IL-17 were associated with a lower rate of serious infection among older adults with psoriatic disease. These biologics may have important safety benefits for older adults with higher infection risk.</jats:p></jats:sec>

Trends in the prevalence and incidence of psoriasis and psoriatic arthritis in Ontario, Canada: a population-based study.

Arthritis Care Res (Hoboken)

Canadian burden of skin disease from 1990 to 2017: results from the Global Burden of Disease 2017 study.

J Cutan Med Surg

Special article: 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis.

Arthritis Rheumatol

Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies.

J Am Acad Dermatol

Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics.

Predicting risk of adverse drug reactions in older adults.

Ther Adv Drug Saf

Infectious disease hospitalizations: United States, 2001 to 2014.

Chest

Representation of older adults in randomized controlled trials on systemic treatment in plaque psoriasis: a systematic review.

Safety of systemic medications among older adults with psoriasis and atopic dermatitis: a systematic review of observational studies.

Older adults on systemic treatment for psoriasis and risk of infection: a propensity score-matched population-based study.

Br J Dermatol

The reporting of studies conducted using observational routinely collected health data statement for pharmacoepidemiology (RECORD-PE).

Coding accuracy of administrative drug claims in the Ontario Drug Benefit database.

Can J Clin Pharmacol

Socioeconomic misclassification in Ontario’s health care registry.

Can J Public Health

Use of postal codes and addresses in the analysis of health data.

Health Rep

Identification of physician-diagnosed Alzheimer’s Disease and related dementias in population-based administrative data: a validation study using family physicians’ electronic medical records.

J Alzheimers Dis

Identifying diabetes cases from administrative data: a population-based validation study.

BMC Health Serv Res

Detecting chronic kidney disease in population-based administrative databases using an algorithm of hospital encounter and physician claim codes.

BMC Nephrol

Identifying cirrhosis, decompensated cirrhosis and hepatocellular carcinoma in health administrative data: A validation study.

PLoS One

Using the Johns Hopkins Aggregated Diagnosis Groups (ADGs) to predict mortality in a general adult population cohort in Ontario, Canada.

Med Care

Glucocorticoid-induced osteoporosis management among seniors, by year, sex, and indication, 1996-2012.

Osteoporos Int

Cox’s regression model for counting processes: a large sample study.

Ann Stat

Accuracy of Canadian health administrative databases in identifying patients with rheumatoid arthritis: a validation study using the medical records of rheumatologists.

Risk of serious infections in patients with psoriasis on biologic therapies: a systematic review and meta-analysis.

J Invest Dermatol

Comparative short-term risks of infection and serious infection in patients receiving biologic and small-molecule therapies for psoriasis and psoriatic arthritis: a systemic review and network meta-analysis of randomized controlled trials.

Ther Adv Chronic Dis

Serious infections among a large cohort of subjects with systemically treated psoriasis.

Risk of serious infection in patients receiving systemic medications for the treatment of psoriasis.

JAMA Dermatol

Cardiovascular and cancer risk with tofacitinib in rheumatoid arthritis.

N Engl J Med

Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.

Cochrane Database Syst Rev

Systemic treatments for psoriatic disease affect the immune system and may increase infection risk. Older adults are at high risk for infection, and the relative safety of systemic treatments for them is unknown.
To evaluate the association of systemic treatments for psoriatic disease with rates of serious infection among older adults.
This cohort study used linked population-based health administrative data from 2002 to 2021 in Ontario, Canada. Participants included Ontario residents 66 years and older with psoriatic disease who were dispensed their first systemic medication between April 1, 2002, and December 31, 2020. Data were analyzed between November 2021 and August 2024.
Time-varying use of systemic medications categorized as (1) methotrexate; (2) other older systemic medications; (3) anti-tumor necrosis factor (anti-TNF) biologics; (4) other biologics (targeting interleukin [IL]-12, IL-23, and IL-17); and (5) tofacitinib.
The main outcome was time to serious infection, defined as hospitalization for any infectious cause occurring up to March 2021. Multivariable Andersen-Gill recurrent event regression was used to estimate the association between each medication category and serious infection rates. The relative rates (RRs) of serious infection with 95% CIs for time actively using each medication category vs time not using that medication category were calculated.
Of 11 641 new users of systemic therapy, 6114 (53%) were female, and the median (IQR) age was 71 (68-76) years. There were 1967 serious infections during a median (IQR) of 4.8 (2.3-8.4) years of follow-up. There were 2.7 serious infections per 100 person-years using methotrexate, 2.5 per 100 person-years using other older systemic drugs, 2.2 per 100 person-years using anti-TNF biologics, 1.4 per 100 person-years using other biologics, and 8.9 per 100 person-years using tofacitinib. In the multivariable-adjusted model, methotrexate (RR, 0.95 [95% CI, 0.85-1.07]), other older systemic medications (RR, 0.92 [95% CI, 0.79-1.07]), and anti-TNF biologics (RR, 0.87 [95% CI, 0.69-1.10]) were not associated with serious infection compared to person-time not using those respective medications. Other biologics (RR, 0.65 [95% CI, 0.48-0.88]) were associated with lower rates of serious infection, whereas tofacitinib (RR, 2.89 [95% CI, 1.14-7.34]) was associated with higher rates of serious infection.
In this cohort study, biologics targeting IL-12, IL-23, or IL-17 were associated with a lower rate of serious infection among older adults with psoriatic disease. These biologics may have important safety benefits for older adults with higher infection risk.

Systemic Therapies for Psoriatic Disease and Serious Infections in Older Adults.

Systemic Therapies for Psoriatic Disease and Serious Infections in Older Adults

Journal of the American Academy of Dermatology

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Pfizer

Utility of azathioprine, methotrexate and cyclosporine as steroid-sparing agents in chronic alopecia areata: a retrospective study of continuation rates in 138 patients

J Eur Acad Dermatol Venereol

Killing two birds with one stone: oral tofacitinib reverses alopecia universalis in a patient with plaque psoriasis

Lymphocytes, neuropeptides, and genes involved in alopecia areata

J Clin Invest

Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition

Nat Med

Two phase 3 trials of baricitinib for alopecia areata

Ruxolitinib cream for the treatment of patients with alopecia areata: a 2-part, double-blind, randomized, vehicle-controlled phase 2 study

A phase 2a randomized vehicle-controlled multi-center study of the safety and efficacy of delgocitinib in subjects with moderate-to-severe alopecia areata

Arch Dermatol Res

Tofacitinib 2% ointment, a topical Janus kinase inhibitor, for the treatment of alopecia areata: a pilot study of 10 patients

Cardiovascular and cancer risk with tofacitinib in rheumatoid arthritis

A review of safety outcomes from clinical trials of baricitinib in rheumatology, dermatology and COVID-19

Adv Ther

Less is more? Failure of one JAK inhibitor does not predict failure of another one in a patient with alopecia areata

Dermatol Ther

Development of the alopecia areata scale for clinical use: results of an academic-industry collaborative effort

Combination tofacitinib and oral minoxidil treatment for severe alopecia areata

Janus kinase (JAK) inhibitors have ushered in a new era in alopecia areata (AA). Historically, moderate-to-severe AA was refractory to treatment. JAK inhibitors have changed that; now, treatment of moderate-to-severe AA is possible. Here, we briefly review the history of and rationale for JAK inhibitor treatment of AA, phase 3 clinical trial data, and considerations regarding differences among JAK inhibitors, safety, and patient selection.

Janus kinase inhibitors for alopecia areata.

Janus kinase inhibitors for alopecia areata

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