2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T789,The guideline panel agreed on 16 recommendations, of which 1 is a strong recommendation, 9 are conditional recommendations, and 6 were identified as knowledge gaps. In adult patients with moderate-to-severely active CD, the AGA recommends the use of infliximab, adalimumab, ustekinumab, risankizumab, mirikizumab, guselkumab, or upadacitinib over no treatment, and suggests the use of certolizumab pegol or vedolizumab over no treatment. In individuals who are naïve to advanced therapies, the AGA suggests using a higher efficacy medication (infliximab, adalimumab, vedolizumab, ustekinumab, risankizumab, mirikizumab, or guselkumab) rather than a lower-efficacy medication (certolizumab pegol or upadacitinib). In individuals who have previously been exposed to 1 or more advanced therapies, the AGA suggests using a higher efficacy medication (adalimumab, risankizumab, guselkumab, or upadacitinib) or intermediate efficacy medication (ustekinumab or mirikizumab) rather than a lower efficacy medication (vedolizumab or certolizumab pegol). In adult outpatients with moderate-to-severely active CD, the AGA suggests against using thiopurine monotherapy for induction of remission, but suggests using thiopurine monotherapy over no treatment for maintenance of (typically corticosteroid-induced) remission. The AGA suggests using subcutaneous methotrexate for induction and maintenance of remission, but suggests against using oral methotrexate. The AGA suggests using combination therapy with infliximab and thiopurines over infliximab monotherapy, particularly in those naïve to thiopurines. The AGA also suggests using initial advanced therapy over step therapy involving corticosteroids and/or immunomodulators in patients with moderate-to-severely active CD. The panel also proposed key implementation considerations for optimal use of these medications, identified several knowledge gaps, and areas for future research.31:Ta0c,This American Gastroenterological Association (AGA) living guideline is intended to support practitioners in the pharmacologic management of moderate-to-severely active Crohn's disease (CD). A multidisciplinary panel of clinical experts and methodologists used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to prioritize clinical questions, identify patient-centered outcomes, conduct an evidence synthesis, and develop recommendations. The guideline panel agreed on 16 recommendations, of which 1 is a strong recommendation, 9 are conditional recommendations, and 6 were identified as knowledge gaps. In adult patients with moderate-to-severely active CD, the AGA recommends the use of infliximab, adalimumab, ustekinumab, risankizumab, mirikizumab, guselkumab, or upadacitinib over no treatment, and suggests the use of certolizumab pegol or vedolizumab over no treatment. In individuals who are naïve to advanced therapies, the AGA suggests using a higher efficacy medication (infliximab, adalimumab, vedolizumab, ustekinumab, risankizumab, mirikizumab, or guselkumab) rather than a lower-efficacy medication (certolizumab pegol or upadacitinib). In individuals who have previously been exposed to 1 or more advanced therapies, the AGA suggests using a higher efficacy medication (adalimumab, risankizumab, guselkumab, or upadacitinib) or intermediate efficacy medication (ustekinumab or mirikizumab) rather than a lower efficacy medication (vedolizumab or certolizumab pegol). In adult outpatients with moderate-to-severely active CD, the AGA suggests against using thiopurine monotherapy for induction of remission, but suggests using thiopurine monotherapy over no treatment for maintenance of (typically corticosteroid-induced) remission. The AGA suggests using subcutaneous methotrexate for induction and maintenance of remission, but suggests against using oral methotrexate. The AGA suggests using combination therapy with infliximab and thiopurines over infliximab monotherapy, particularly in those naïve to thiopurines. The AGA also suggests using initial advanced therapy over step therapy involving corticosteroids and/or immunomodulators in patients with moderate-to-severely active CD. The panel also proposed key implementation considerations for optimal use of these medications, identified several knowledge gaps, and areas for future research. This guideline provides a comprehensive, patient-centered, evidence-based approach to the pharmacologic management of patients with moderate-to-severely active CD.32:T710,Many biologic therapies are available for moderate-to-severe plaque psoriasis. A systematic literature review and network meta-analysis (NMA) was conducted to compare the efficacy of the interleukin (IL)-23 inhibitor, tildrakizumab, with other biologics at up to 28 weeks of treatment. The literature search was conducted on January 22, 2024, searching MEDLINE, Embase, and CENTRAL for randomized controlled trials (RCTs) investigating the comparative efficacy and safety of biologics in adult Asian patients with moderate-to-severe plaque psoriasis. NMAs were conducted for ≥ 75%, ≥ 90%, and 100% reduction in Psoriasis Area and Severity Index score (PASI 75, 90, and 100) and achieving a Physician Global Assessment (PGA) score of 0 or 1 after the induction period (12 and 16 weeks) and mid-term (28 weeks) follow-up. NMAs were conducted using the Bayesian framework outlined in the National Institute of Clinical Excellence guidelines. Nineteen RCTs conducted in China, Japan, Korea, and Taiwan with 11 different biologics were included. At Week 12, tildrakizumab had lower efficacy compared to other biologics. Between Weeks 12 and 28, the proportion of patients achieving PASI 75/90/100 with tildrakizumab increased from 60.77% to 81.84%, from 38.54% to 71.23%, and from 6.97% to 22.64%, respectively. At Week 28, tildrakizumab efficacy was comparable to other biologic therapies studied here, including tumor necrosis factor-alpha (TNFα), IL-17, IL-12/IL-23, and other IL-23 inhibitors. The efficacy of tildrakizumab improved over time, which underscores the importance of evaluating the sustained efficacy of tildrakizumab over the long term. Combined with low dosing frequency, tildrakizumab offers an effective treatment option for patients with moderate-to-severe plaque psoriasis.33:T760,ABSTRACTMany biologic therapies are available for moderate‐to‐severe plaque psoriasis. A systematic literature review and network meta‐analysis (NMA) was conducted to compare the efficacy of the interleukin (IL)‐23 inhibitor, tildrakizumab, with other biologics at up to 28 weeks of treatment. The literature search was conducted on January 22, 2024, searching MEDLINE, Embase, and CENTRAL for randomized controlled trials (RCTs) investigating the comparative efficacy and safety of biologics in adult Asian patients with moderate‐to‐severe plaque psoriasis. NMAs were conducted for ≥ 75%, ≥ 90%, and 100% reduction in Psoriasis Area and Severity Index score (PASI 75, 90, and 100) and achieving a Physician Global Assessment (PGA) score of 0 or 1 after the induction period (12 and 16 weeks) and mid‐term (28 weeks) follow‐up. NMAs were conducted using the Bayesian framework outlined in the National Institute of Clinical Excellence guidelines. Nineteen RCTs conducted in China, Japan, Korea, and Taiwan with 11 different biologics were included. At Week 12, tildrakizumab had lower efficacy compared to other biologics. Between Weeks 12 and 28, the proportion of patients achieving PASI 75/90/100 with tildrakizumab increased from 60.77% to 81.84%, from 38.54% to 71.23%, and from 6.97% to 22.64%, respectively. At Week 28, tildrakizumab efficacy was comparable to other biologic therapies studied here, including tumor necrosis factor‐alpha (TNFα), IL‐17, IL‐12/IL‐23, and other IL‐23 inhibitors. The efficacy of tildrakizumab improved over time, which underscores the importance of evaluating the sustained efficacy of tildrakizumab over the long term. Combined with low dosing frequency, tildrakizumab offers an effective treatment option for patients with moderate‐to‐severe plaque psoriasis.34:Tbcc,Patients with psoriasis may require a switch to another therapy due to high treatment costs, primary effectiveness failure, biologic fatigue, or adverse effects associated with the initial biologic treatment; however, the availability of evidence for the effectiveness and safety of interclass biologic switching for the treatment of psoriasis is unknown. To investigate the effectiveness and safety of psoriasis treatment after the failure of initial biologic therapy, particularly when patients switch to a second biologic. PubMed, Embase, and the Cochrane Library were searched from inception through January 25, 2025. The study included randomized clinical trials (RCTs) of patients with plaque psoriasis aged 18 years or older involving crossover or switching from 1 biologic agent to another initial biologic within the same or different drug class. Two researchers independently screened the records and abstracted data using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Data were pooled using random-effects models. The prespecified primary end point was psoriasis area and severity index (PASI) 90. Secondary end points included clinician- and patient-reported outcomes (PROMs) and safety. Clinical effectiveness was evaluated based on the PASI responses (PASI 75, 90, and 100) and the Investigator's and Physician's Global Assessments scores of 0 or 1 and body surface area of 1% or less. PROMs included the dermatology life quality index and psoriasis symptoms and signs diary. Safety concerns included adverse events (AEs), serious AEs, severe AEs, treatment-related AEs, and specific AEs. Twenty-four RCTs involving 12 661 patients with psoriasis and 8 switching categories were analyzed. Significant differences observed in PASI 90 between week 4 and week 0 (odds ratio [OR], 6.53; 95% CI, 2.58-16.51). Substantial disparities were noted across various PASI response metrics, specifically PASI 90 (OR, 28.61; 95% CI, 12.89-63.47), PASI 75 (OR, 11.11; 95% CI, 5.95-20.75), and PASI 100 (OR, 18.76; 95% CI, 8.37-42.01). No difference exists in safety outcomes between the end point and week 0, including in serious AEs (OR, 1.63; 95% CI, 0.72-3.69), severe AEs (OR, 1.40; 95% CI, 0.61-3.26), and treatment-related AEs (OR, 1.79; 95% CI, 0.41-7.88). The highest risk of infection was associated with switching from anti-TNF-α agents to anti-interleukin (IL)-23p19, anti-IL-17A, or anti-IL-12/23p40 agents, with infection rates of 0.62%, 0.54% and 0.39%, respectively. This systematic review and meta-analysis found that interclass biologic switching was effective in a significant number of patients. With the introduction of biologics with diverse mechanisms of action, these options may become viable and potentially superior. However, further confirmatory data from larger patient cohorts and longer follow-up periods are required to obtain more conclusive results. Our results highlight the importance of vigilance for infections when switching biologics.35:Tef0,ImportancePatients with psoriasis may require a switch to another therapy due to high treatment costs, primary effectiveness failure, biologic fatigue, or adverse effects associated with the initial biologic treatment; however, the availability of evidence for the effectiveness and safety of interclass biologic switching for the treatment of psoriasis is unknown.ObjectiveTo investigate the effectiveness and safety of psoriasis treatment after the failure of initial biologic therapy, particularly when patients switch to a second biologic.Data SourcesPubMed, Embase, and the Cochrane Library were searched from inception through January 25, 2025.Study SelectionThe study included randomized clinical trials (RCTs) of patients with plaque psoriasis aged 18 years or older involving crossover or switching from 1 biologic agent to another initial biologic within the same or different drug class.Data Extraction and SynthesisTwo researchers independently screened the records and abstracted data using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Data were pooled using random-effects models.Main Outcomes and MeasuresThe prespecified primary end point was psoriasis area and severity index (PASI) 90. Secondary end points included clinician- and patient-reported outcomes (PROMs) and safety. Clinical effectiveness was evaluated based on the PASI responses (PASI 75, 90, and 100) and the Investigator’s and Physician’s Global Assessments scores of 0 or 1 and body surface area of 1% or less. PROMs included the dermatology life quality index and psoriasis symptoms and signs diary. Safety concerns included adverse events (AEs), serious AEs, severe AEs, treatment-related AEs, and specific AEs.ResultsTwenty-four RCTs involving 12 661 patients with psoriasis and 8 switching categories were analyzed. Significant differences observed in PASI 90 between week 4 and week 0 (odds ratio [OR], 6.53; 95% CI, 2.58-16.51). Substantial disparities were noted across various PASI response metrics, specifically PASI 90 (OR, 28.61; 95% CI, 12.89-63.47), PASI 75 (OR, 11.11; 95% CI, 5.95-20.75), and PASI 100 (OR, 18.76; 95% CI, 8.37-42.01). No difference exists in safety outcomes between the end point and week 0, including in serious AEs (OR, 1.63; 95% CI, 0.72-3.69), severe AEs (OR, 1.40; 95% CI, 0.61-3.26), and treatment-related AEs (OR, 1.79; 95% CI, 0.41-7.88). The highest risk of infection was associated with switching from anti−TNF-α agents to anti−interleukin (IL)-23p19, anti−IL-17A, or anti−IL-12/23p40 agents, with infection rates of 0.62%, 0.54% and 0.39%, respectively.Conclusions and RelevanceThis systematic review and meta-analysis found that interclass biologic switching was effective in a significant number of patients. With the introduction of biologics with diverse mechanisms of action, these options may become viable and potentially superior. However, further confirmatory data from larger patient cohorts and longer follow-up periods are required to obtain more conclusive results. Our results highlight the importance of vigilance for infections when switching biologics.36:Ta61,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.37:Td19,ImportanceSystemic 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.ObjectiveTo evaluate the association of systemic treatments for psoriatic disease with rates of serious infection among older adults.Design, Setting, and ParticipantsThis 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.ExposureTime-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.Main Outcomes and MeasuresThe 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.ResultsOf 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.Conclusions and RelevanceIn 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.38:T43f,A total of 122 308 patients with CISDs (median [IQR] age, 49 [38-58] years; 63 663 [52.1%] male) starting systemic immunomodulatory treatment in the US were included. Treatment for patients with CISDs comprised methotrexate (28 684), tumor necrosis factor α inhibitors (40 965), ustekinumab (12 841), IL-23i (6116), IL-17Ai (9799), dupilumab (7787), or apremilast (16 116). Complete blood cell count was the most common test, performed in 41% (3161/7787) to 69% (19 659/28 684) of individuals before initiation across treatments. Between 11% (889/7787) and 59% (3613/6116) of patients had tuberculosis screening within 6 months before treatment, and 3% (149/4577) to 26% (1559/6097) had updated tests 1 year later. Between 13% (1006/7787) and 41% (16 728/40 965) had hepatitis panels before treatment. Low pretreatment testing levels before apremilast (15% [2331/16 116] to 45% [7253/16 116]) persisted a year into treatment (9% [816/8496] to 36% [2999/8496]) and were similar to dupilumab (11% [850/7787] to 41% [3161/7787] vs 3% [149/4577] to 25% [1160/4577]).39:T98b,Laboratory testing for the presence of tuberculosis, hepatitis, and other conditions before starting most systemic immunomodulatory agents is recommended in patients with chronic inflammatory skin diseases (CISD) but current testing patterns in the US are unclear. To determine the prevalence of pretreatment testing that is recommended for patients with CISD (psoriasis, hidradenitis suppurativa, or atopic dermatitis). This descriptive analysis of US commercial insurance claims databases from December 31, 2002, to December 31, 2020, included adult patients with CISD (psoriasis, hidradenitis suppurativa, or atopic dermatitis) who started an immunomodulatory agent, including methotrexate, tumor necrosis factor α inhibitors, interleukin (IL)-17Ai, ustekinumab, IL-23i, dupilumab, or apremilast. The proportion of patients who underwent the screening tests as suggested by professional societies-including for tuberculosis, hepatitis, and liver function; complete blood cell counts; and lipid panels-were determined within 6 months before and during 2 years after treatment start. A total of 122 308 patients with CISDs (median [IQR] age, 49 [38-58] years; 63 663 [52.1%] male) starting systemic immunomodulatory treatment in the US were included. Treatment for patients with CISDs comprised methotrexate (28 684), tumor necrosis factor α inhibitors (40 965), ustekinumab (12 841), IL-23i (6116), IL-17Ai (9799), dupilumab (7787), or apremilast (16 116). Complete blood cell count was the most common test, performed in 41% (3161/7787) to 69% (19 659/28 684) of individuals before initiation across treatments. Between 11% (889/7787) and 59% (3613/6116) of patients had tuberculosis screening within 6 months before treatment, and 3% (149/4577) to 26% (1559/6097) had updated tests 1 year later. Between 13% (1006/7787) and 41% (16 728/40 965) had hepatitis panels before treatment. Low pretreatment testing levels before apremilast (15% [2331/16 116] to 45% [7253/16 116]) persisted a year into treatment (9% [816/8496] to 36% [2999/8496]) and were similar to dupilumab (11% [850/7787] to 41% [3161/7787] vs 3% [149/4577] to 25% [1160/4577]). In this descriptive analysis of patients with CISDs starting systemic immunomodulatory treatment in the US, less than 60% received the recommended pretreatment testing. Additional research is required to understand whether variations in testing affect patient outcomes.3a:Tbec,ImportanceLaboratory testing for the presence of tuberculosis, hepatitis, and other conditions before starting most systemic immunomodulatory agents is recommended in patients with chronic inflammatory skin diseases (CISD) but current testing patterns in the US are unclear.ObjectiveTo determine the prevalence of pretreatment testing that is recommended for patients with CISD (psoriasis, hidradenitis suppurativa, or atopic dermatitis).Design, Setting, and ParticipantsThis descriptive analysis of US commercial insurance claims databases from December 31, 2002, to December 31, 2020, included adult patients with CISD (psoriasis, hidradenitis suppurativa, or atopic dermatitis) who started an immunomodulatory agent, including methotrexate, tumor necrosis factor α inhibitors, interleukin (IL)–17Ai, ustekinumab, IL-23i, dupilumab, or apremilast.Main Outcomes and MeasuresThe proportion of patients who underwent the screening tests as suggested by professional societies—including for tuberculosis, hepatitis, and liver function; complete blood cell counts; and lipid panels—were determined within 6 months before and during 2 years after treatment start.ResultsA total of 122 308 patients with CISDs (median [IQR] age, 49 [38-58] years; 63 663 [52.1%] male) starting systemic immunomodulatory treatment in the US were included. Treatment for patients with CISDs comprised methotrexate (28 684), tumor necrosis factor α inhibitors (40 965), ustekinumab (12 841), IL-23i (6116), IL-17Ai (9799), dupilumab (7787), or apremilast (16 116). Complete blood cell count was the most common test, performed in 41% (3161/7787) to 69% (19 659/28 684) of individuals before initiation across treatments. Between 11% (889/7787) and 59% (3613/6116) of patients had tuberculosis screening within 6 months before treatment, and 3% (149/4577) to 26% (1559/6097) had updated tests 1 year later. Between 13% (1006/7787) and 41% (16 728/40 965) had hepatitis panels before treatment. Low pretreatment testing levels before apremilast (15% [2331/16 116] to 45% [7253/16 116]) persisted a year into treatment (9% [816/8496] to 36% [2999/8496]) and were similar to dupilumab (11% [850/7787] to 41% [3161/7787] vs 3% [149/4577] to 25% [1160/4577]).Conclusions and RelevanceIn this descriptive analysis of patients with CISDs starting systemic immunomodulatory treatment in the US, less than 60% received the recommended pretreatment testing. Additional research is required to understand whether variations in testing affect patient outcomes.3b:T470,Of 56 553 drug exposures considered, 24 997 from 13 699 participants were included. The 24 997 included exposures (median age, 46 years [IQR, 36-55 years]; 57% male) accrued a total exposure time of 81 441 patient-years. A total of 273 exposures (1%) were associated with paradoxical eczema. The adjusted incidence rates were 1.22 per 100 000 person-years for IL-17 inhibitors, 0.94 per 100 000 person-years for TNF inhibitors, 0.80 per 100 000 person-years for IL-12/23 inhibitors, and 0.56 per 100 000 person-years for IL-23 inhibitors. Compared with TNF inhibitors, IL-23 inhibitors were associated with a lower risk of paradoxical eczema (hazard ratio [HR], 0.39; 95% CI, 0.19-0.81), and there was no association of IL-17 inhibitors (HR, 1.03; 95% CI, 0.74-1.42) or IL-12/23 inhibitors (HR, 0.87; 95% CI, 0.66-1.16) with risk of paradoxical eczema. Increasing age (HR, 1.02 per year; 95% CI, 1.01-1.03) and history of AD (HR, 12.40; 95% CI, 6.97-22.06) or hay fever (HR, 3.78; 95% CI, 1.49-9.53) were associated with higher risk of paradoxical eczema. There was a lower risk in males (HR, 0.60; 95% CI, 0.45-0.78).3c:Ta5c,Biologics used for plaque psoriasis have been reported to be associated with an atopic dermatitis (AD) phenotype, or paradoxical eczema, in some patients. The risk factors for this are unknown. To explore risk of paradoxical eczema by biologic class and identify factors associated with paradoxical eczema. This prospective cohort study used data from the British Association of Dermatologists Biologics and Immunomodulators Register for adults treated with biologics for plaque psoriasis who were seen at multicenter dermatology clinics in the UK and Ireland. Included participants were registered and had 1 or more follow-up visits between September 2007 and December 2022. Duration of exposure to tumor necrosis factor (TNF) inhibitors, interleukin (IL) 17 inhibitors, IL-12/23 inhibitors, or IL-23 inhibitors until paradoxical eczema onset, treatment discontinuation, last follow-up, or death. Incidence rates of paradoxical eczema, paradoxical eczema risk by biologic class, and the association of demographic and clinical variables with risk of paradoxical eczema were assessed using propensity score-weighted Cox proportional hazards regression models. Of 56 553 drug exposures considered, 24 997 from 13 699 participants were included. The 24 997 included exposures (median age, 46 years [IQR, 36-55 years]; 57% male) accrued a total exposure time of 81 441 patient-years. A total of 273 exposures (1%) were associated with paradoxical eczema. The adjusted incidence rates were 1.22 per 100 000 person-years for IL-17 inhibitors, 0.94 per 100 000 person-years for TNF inhibitors, 0.80 per 100 000 person-years for IL-12/23 inhibitors, and 0.56 per 100 000 person-years for IL-23 inhibitors. Compared with TNF inhibitors, IL-23 inhibitors were associated with a lower risk of paradoxical eczema (hazard ratio [HR], 0.39; 95% CI, 0.19-0.81), and there was no association of IL-17 inhibitors (HR, 1.03; 95% CI, 0.74-1.42) or IL-12/23 inhibitors (HR, 0.87; 95% CI, 0.66-1.16) with risk of paradoxical eczema. Increasing age (HR, 1.02 per year; 95% CI, 1.01-1.03) and history of AD (HR, 12.40; 95% CI, 6.97-22.06) or hay fever (HR, 3.78; 95% CI, 1.49-9.53) were associated with higher risk of paradoxical eczema. There was a lower risk in males (HR, 0.60; 95% CI, 0.45-0.78). In this study, in biologic-treated patients with psoriasis, paradoxical eczema risk was lowest in patients receiving IL-23 inhibitors. Increasing age, female sex, and history of AD or hay fever were associated with higher risk of paradoxical eczema. The overall incidence of paradoxical eczema was low. Further study is needed to replicate these findings.3d:Td15,ImportanceBiologics used for plaque psoriasis have been reported to be associated with an atopic dermatitis (AD) phenotype, or paradoxical eczema, in some patients. The risk factors for this are unknown.ObjectiveTo explore risk of paradoxical eczema by biologic class and identify factors associated with paradoxical eczema.Design, Setting, and ParticipantsThis prospective cohort study used data from the British Association of Dermatologists Biologics and Immunomodulators Register for adults treated with biologics for plaque psoriasis who were seen at multicenter dermatology clinics in the UK and Ireland. Included participants were registered and had 1 or more follow-up visits between September 2007 and December 2022.ExposuresDuration of exposure to tumor necrosis factor (TNF) inhibitors, interleukin (IL) 17 inhibitors, IL-12/23 inhibitors, or IL-23 inhibitors until paradoxical eczema onset, treatment discontinuation, last follow-up, or death.Main Outcomes and MeasuresIncidence rates of paradoxical eczema, paradoxical eczema risk by biologic class, and the association of demographic and clinical variables with risk of paradoxical eczema were assessed using propensity score–weighted Cox proportional hazards regression models.ResultsOf 56 553 drug exposures considered, 24 997 from 13 699 participants were included. The 24 997 included exposures (median age, 46 years [IQR, 36-55 years]; 57% male) accrued a total exposure time of 81 441 patient-years. A total of 273 exposures (1%) were associated with paradoxical eczema. The adjusted incidence rates were 1.22 per 100 000 person-years for IL-17 inhibitors, 0.94 per 100 000 person-years for TNF inhibitors, 0.80 per 100 000 person-years for IL-12/23 inhibitors, and 0.56 per 100 000 person-years for IL-23 inhibitors. Compared with TNF inhibitors, IL-23 inhibitors were associated with a lower risk of paradoxical eczema (hazard ratio [HR], 0.39; 95% CI, 0.19-0.81), and there was no association of IL-17 inhibitors (HR, 1.03; 95% CI, 0.74-1.42) or IL-12/23 inhibitors (HR, 0.87; 95% CI, 0.66-1.16) with risk of paradoxical eczema. Increasing age (HR, 1.02 per year; 95% CI, 1.01-1.03) and history of AD (HR, 12.40; 95% CI, 6.97-22.06) or hay fever (HR, 3.78; 95% CI, 1.49-9.53) were associated with higher risk of paradoxical eczema. There was a lower risk in males (HR, 0.60; 95% CI, 0.45-0.78).Conclusions and RelevanceIn this study, in biologic-treated patients with psoriasis, paradoxical eczema risk was lowest in patients receiving IL-23 inhibitors. Increasing age, female sex, and history of AD or hay fever were associated with higher risk of paradoxical eczema. The overall incidence of paradoxical eczema was low. Further study is needed to replicate these findings.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"IL-12/23 Inhibitor: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on IL-12/23 Inhibitor (modality). Clinician-written summaries and actionable practice insights. 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no meta-analysis was conducted due to methodological heterogeneity.","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0797","tag_type":"warning","value":"Sex tag set to 'female' as the primary dataset covers maternal exposure; paternal exposure studies also exist but are a small subset (3 studies, 281 pregnancies).","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0797","tag_type":"warning","value":"The review included all indications for IL inhibitors (not psoriasis-only), so findings may not be fully generalizable to psoriasis patients specifically.","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0797","tag_type":"warning","value":"The sample size (n=5,962) reflects maternal pregnancy exposures across all included studies, not a single trial cohort; the majority originated from pharmacovigilance databases with inherent reporting bias.","value_numeric":null}],"summaries":{"what_studied":"A PRISMA-compliant systematic literature review (search date May 2026) evaluated the reproductive safety of IL-12/23, IL-17, and IL-23 inhibitors during pregnancy and with paternal exposure in patients with psoriasis, examining pregnancy and neonatal outcomes across all available study designs.","key_result":"49 publications met inclusion criteria, reporting 5,962 pregnancies with maternal exposure; ustekinumab had the most data (2,933 pregnancies), followed by secukinumab (1,877), risankizumab (589), ixekizumab (296), guselkumab (217), tildrakizumab (32), bimekizumab (11), brodalumab (6), and mirikizumab (1). Cohort-level findings were generally reassuring — no consistent signal for adverse pregnancy or neonatal outcomes — except one study reporting increased risk of small-for-gestational-age infants with ustekinumab. Paternal exposure data were very limited (3 studies, 281 pregnancies).","limitations":"- Most exposures (n=5,074) came from pharmacovigilance databases that capture only adverse events, making incidence rates incalculable and meta-analysis infeasible.\n- Critical confounders (disease activity, exposure timing, comedications) were missing or unreported in the majority of studies; only one study used confounder-adjusted analysis.\n- Data were heavily skewed toward IBD patients, limiting psoriasis-specific and IL-17-specific conclusions.","practice_takeaway":"Available data are broadly reassuring but insufficient to issue definitive safety guidance; clinicians should weigh uncontrolled disease risk against medication uncertainty on a case-by-case basis. Existing psoriasis registries (e.g., BADBIR, BioCAPTURE) should add standardized pregnancy datasets to accelerate evidence generation."}},{"doi":"10.2340/actadv.v106.adv-2026-0490","pmid":"42708647","title":"The Efficacy of Different Treatment Options in Cutaneous Sarcoidosis: A Meta-analysis of RCTs","journal_title":"Acta Dermato-Venereologica","journal_issn":"1651-2057","published_at":"2026-09-08T00:00:00.000Z","url":"https://doi.org/10.2340/actadv.v106.adv-2026-0490","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-12T06:20:16.284Z","updated_at":"2026-09-12T06:20:16.284Z","tags":[{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"brand","value":"Humira","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"brand","value":"Rapamune","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"brand","value":"Remicade","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"brand","value":"Simponi","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"brand","value":"Stelara","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"condition","value":"Cutaneous Sarcoidosis","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"generic","value":"adalimumab","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"generic","value":"golimumab","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"generic","value":"infliximab","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"generic","value":"sirolimus","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"generic","value":"thalidomide","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"generic","value":"ustekinumab","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"modality","value":"Antimycobacterial Combination Therapy","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"modality","value":"IL-12/23 Inhibitor","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"modality","value":"Immunomodulatory Agent","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"modality","value":"mTOR Inhibitor","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"modality","value":"TNF-alpha Inhibitor","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"sample_size","value":"n=156","value_numeric":156},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"study_design","value":"Systematic Review and Meta-analysis","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"warning","value":"Only 6 RCTs with 156 participants were pooled; the meta-analysis is substantially underpowered and results should be interpreted with caution.","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"warning","value":"Publication bias could not be formally assessed due to the small number of included studies.","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"warning","value":"Race and ethnicity data were inconsistently reported across trials, preventing subgroup analyses by demographic factors.","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"warning","value":"The Judson 2014 trial included both golimumab and ustekinumab arms with a shared placebo group; the authors split the placebo arm proportionally to avoid unit-of-analysis errors, which introduces analytical uncertainty.","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2026-0490","tag_type":"warning","value":"The level of evidence tag '1' reflects the meta-analysis of RCTs study design, but GRADE certainty was rated 'very low' due to risk of bias, imprecision, and heterogeneity — the clinical confidence in the pooled estimates is therefore much lower than the design hierarchy alone implies.","value_numeric":null}],"summaries":{"what_studied":"This systematic review and meta-analysis of 6 double-blind, placebo-controlled RCTs (n=156 adults) evaluated the efficacy and safety of pharmacological add-on therapies — including infliximab, adalimumab, golimumab, ustekinumab, thalidomide, sirolimus (topical mTOR inhibitor), and the CLEAR antimycobacterial regimen — for cutaneous sarcoidosis, with all trials permitting concomitant corticosteroids.","key_result":"No pharmacological therapy significantly improved clinical response over placebo (OR 2.24; 95% CI 0.73–6.90; p=0.16). A non-significant trend toward better quality of life was seen (OR 2.23; 95% CI 0.87–5.73; p=0.09). Serious adverse events were similar between groups (OR 0.97; 95% CI 0.48–1.96; p=0.93). Overall certainty of evidence was very low (GRADE).","limitations":"- Only 6 RCTs with 156 total participants; severely underpowered for definitive conclusions.\n- Risk of bias was moderate-to-high in 4 of 6 studies, mainly due to missing outcome data and inadequate allocation concealment.\n- All trials allowed concurrent corticosteroids without standardized dosing or tapering, which may have blunted detection of treatment benefit. Publication bias could not be assessed.","practice_takeaway":"Current RCT evidence does not support a statistically significant benefit of steroid-sparing add-on therapies for cutaneous sarcoidosis; individualize treatment based on disease severity, comorbidities, and patient preferences. Emerging agents (JAK inhibitors, mTOR inhibitors) show promise in case reports but lack controlled trial data — do not use as standard care yet."}},{"doi":"10.1007/s10620-026-10231-1","pmid":"42704580","title":"IBD Nurse-Led Clinical Pathways to Optimize Patient Safety in Advanced Therapies: A Narrative Review","journal_title":"Digestive Diseases and Sciences","journal_issn":"0163-2116","published_at":"2026-09-07T00:00:00.000Z","url":"https://doi.org/10.1007/s10620-026-10231-1","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-15T06:17:42.129Z","updated_at":"2026-09-15T06:17:42.129Z","tags":[{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"condition","value":"Crohn's Disease","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"condition","value":"Inflammatory Bowel Disease","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"condition","value":"Ulcerative Colitis","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"adalimumab","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"azathioprine","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"etrasimod","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"filgotinib","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"golimumab","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"guselkumab","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"infliximab","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"mirikizumab","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"obefazimod","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"ozanimod","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"risankizumab","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"tofacitinib","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"upadacitinib","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"ustekinumab","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"generic","value":"vedolizumab","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"modality","value":"Anti-Integrin","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"modality","value":"Anti-TNF Agent","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"modality","value":"IL-12/23 Inhibitor","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"modality","value":"IL-23 Inhibitor","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"modality","value":"JAK Inhibitor","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"modality","value":"S1P Receptor Modulator","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"warning","value":"Evidence maturity varies considerably across domains: infection screening and infusion safety are well-supported, while remote monitoring and small-molecule nursing roles rest on a more heterogeneous evidence base.","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"warning","value":"No sample size applies — this is a narrative review synthesizing existing literature, not a primary study with enrolled participants.","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"warning","value":"Sex of study populations is not reported, as this review aggregates evidence across multiple heterogeneous sources.","value_numeric":null},{"paper_doi":"10.1007/s10620-026-10231-1","tag_type":"warning","value":"The seven nursing domains represent an interpretative synthesis, not a validated clinical framework; they have not undergone formal consensus, feasibility testing, or outcome evaluation.","value_numeric":null}],"summaries":{"what_studied":"This narrative review synthesized clinical, organizational, and nursing evidence on the role of specialist IBD nurses in managing biologic and small-molecule therapies, drawing on ECCO, BSG, and ACG guidelines plus literature up to December 2025 (with an August 2026 update).","key_result":"Seven interrelated nursing practice domains were identified: pretreatment assessment, therapy preparation, IV infusion management, self-administered therapy management, clinical and laboratory monitoring, critical event management, and core knowledge of biologic/small-molecule therapies. An eighth complementary section covers emerging therapies and special contexts (pregnancy, perianal disease, travel, pediatric/adolescent transition).","limitations":"- Narrative design lacks the exhaustiveness, reproducibility, and formal evidence appraisal of a systematic review; relevant sources may have been missed.\n- Included literature is highly heterogeneous (guidelines, observational studies, service reports, digital-health evaluations), limiting comparative conclusions about individual pathway components.\n- No formal framework-development process was conducted (no expert consensus, stakeholder validation, feasibility testing, or implementation evaluation), so the thematic domains should not be treated as a validated clinical framework or standard of care.","practice_takeaway":"IBD nurses should follow structured, protocol-driven pathways across all phases of advanced therapy—from infectious screening and pharmacogenetic testing before initiation, to predefined escalation algorithms for infusion reactions, infections, VTE, and cardiovascular events. Centers developing or expanding IBD nursing services can use the seven domains as an evidence-informed starting point, while recognizing that formal validation and local adaptation are still needed."}},{"doi":"10.1016/j.cgh.2026.08.014","pmid":"42660257","title":"Clinical Outcomes After Ustekinumab Biosimilar Switching in Crohn’s Disease: the USBIOS IG-IBD Study","journal_title":"Clinical Gastroenterology and Hepatology","journal_issn":"1542-3565","published_at":"2026-08-27T00:00:00.000Z","url":"https://doi.org/10.1016/j.cgh.2026.08.014","source_score":10,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-01T06:21:08.279Z","updated_at":"2026-09-01T06:21:08.279Z","tags":[{"paper_doi":"10.1016/j.cgh.2026.08.014","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.014","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.014","tag_type":"condition","value":"Crohn's Disease","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.014","tag_type":"generic","value":"ustekinumab","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.014","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.014","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.014","tag_type":"modality","value":"IL-12/23 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.014","tag_type":"sample_size","value":"n=462","value_numeric":462},{"paper_doi":"10.1016/j.cgh.2026.08.014","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.014","tag_type":"study_design","value":"Prospective Observational Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.014","tag_type":"warning","value":"Brand names of the 3 specific biosimilars used are not listed in the abstract; brand/generic tags for individual biosimilars could not be added.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.014","tag_type":"warning","value":"Every-4-week dosing subgroup is very small (n=4, 0.9%), limiting any subgroup inference for that population.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.08.014","tag_type":"warning","value":"The control group (n=125) was not randomly assigned; procurement-driven allocation may introduce unmeasured confounding despite propensity-score adjustment.","value_numeric":null}],"summaries":{"what_studied":"This prospective observational cohort study at 18 Italian centers compared 6-month clinical outcomes in adults with Crohn's disease (CD) in stable remission who underwent a procurement-driven nonmedical switch from reference ustekinumab to one of 3 approved biosimilars (n=337) versus those who continued reference treatment (n=125).","key_result":"Expanded clinical success (remission, steroid-free, no biologic discontinuation, no IBD hospitalization or surgery) was achieved in 92.2% of switchers vs. 92.7% of controls (risk difference −0.5%, 95% CI −5.9 to 4.9), meeting the prespecified noninferiority margin of −15%. Biosimilar persistence was 93.7%; switch-back rate was 1.2%; only 2 adverse events were reported after switching.","limitations":"- Observational design with unequal group sizes (337 vs. 125) and potential selection bias, despite propensity-score weighting.\n- Only 4 patients (0.9%) were on every-4-week dosing, so results may not generalize to this higher-intensity subgroup.\n- Follow-up was limited to 6 months; longer-term durability of biosimilar switching remains unknown.","practice_takeaway":"For clinically stable CD patients on reference ustekinumab, a nonmedical switch to an approved biosimilar appears safe and effective over 6 months, with outcomes virtually identical to staying on the reference product. Clinicians can proceed with procurement-driven switches in this population but should monitor patients on every-4-week dosing more closely, as evidence is very limited for that group."}},{"doi":"10.14309/ajg.0000000000004119","pmid":"42467952","title":"Absolute Risk of Malignancy by Treatment in Patients With Crohn's Disease Compared with the General Population: A Nationwide Population-Based Cohort Study","journal_title":"American Journal of Gastroenterology","journal_issn":"0002-9270","published_at":"2026-08-26T00:00:00.000Z","url":"https://doi.org/10.14309/ajg.0000000000004119","source_score":14,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-28T06:25:32.491Z","updated_at":"2026-08-28T06:25:32.491Z","tags":[{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"brand","value":"Entyvio","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"brand","value":"Stelara","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"condition","value":"Crohn's Disease","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"condition","value":"Malignancy","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"condition","value":"Nonmelanoma Skin Cancer","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"generic","value":"azathioprine","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"generic","value":"ustekinumab","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"generic","value":"vedolizumab","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"modality","value":"IL-12/23 Inhibitor","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"modality","value":"Integrin Inhibitor","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"modality","value":"Thiopurine","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"modality","value":"TNF Inhibitor","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"sample_size","value":"n=38733","value_numeric":38733},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"study_design","value":"Population-Based Cohort Study","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"warning","value":"Comparator group (n=360,616) is substantially larger than the patient cohort; matching details and ratio are not fully described in the abstract.","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"warning","value":"Impact flag 'practice_changing' applied cautiously — findings reinforce skin cancer surveillance across all CD patients and may influence biologic selection, but vedolizumab/ustekinumab results are underpowered.","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"warning","value":"The 'once-exposed-always-exposed' design means patients are kept in a treatment cohort regardless of stopping or switching therapy, which may overestimate or distort treatment-specific cancer risk.","value_numeric":null},{"paper_doi":"10.14309/ajg.0000000000004119","tag_type":"warning","value":"The thiopurine generic tag uses azathioprine as a representative agent; the paper refers broadly to thiopurines, which may also include mercaptopurine or thioguanine.","value_numeric":null}],"summaries":{"what_studied":"This nationwide Swedish register-based cohort study assessed absolute cancer risk in 38,733 patients with Crohn's disease (CD) across six treatment cohorts (thiopurine, TNFi, thiopurine+TNFi, vedolizumab, ustekinumab, and immunomodulator-naïve) versus 360,616 matched general-population comparators, followed for a median of 7.3 years (2007–2023).","key_result":"Excess cancer incidence (vs. general population) ranged from 1.54 to 3.14 per 1,000 person-years across all treatment groups, including naïve patients (2.43; 95% CI 1.92–2.94); nonmelanoma skin cancer drove most of the excess. After excluding nonmelanoma skin cancers, excess incidence fell to ~1 extra case per 1,000 person-years in naïve, thiopurine, and TNFi cohorts (driven by lung, small bowel, hepatobiliary, and hematologic cancers), and was not significantly elevated in vedolizumab or ustekinumab groups.","limitations":"- Once-exposed-always-exposed design may not capture treatment duration or switching effects accurately.\n- Residual confounding by disease severity and indication bias cannot be excluded, as sicker patients are more likely to receive immunomodulators.\n- Ustekinumab and vedolizumab cohorts had wide confidence intervals, suggesting limited statistical power for those groups.","practice_takeaway":"All CD patients—even those on no immunomodulatory therapy—carry a modestly elevated cancer risk vs. the general population, largely from nonmelanoma skin cancer; counsel patients across all treatment lines about skin surveillance. After excluding skin cancers, vedolizumab and ustekinumab users did not show a statistically significant excess cancer risk, which may be reassuring when choosing therapy for higher-risk patients."}},{"doi":"10.1002/art.70297","pmid":"42605840","title":"Risk of Cancer according to Duration of Targeted Therapy Exposure in Spondyloarthritis: A Nationwide Cohort Study from the French Health Insurance Database","journal_title":"Arthritis & Rheumatology","journal_issn":"2326-5191","published_at":"2026-08-17T00:00:00.000Z","url":"https://doi.org/10.1002/art.70297","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-22T06:53:21.288Z","updated_at":"2026-08-22T06:53:21.288Z","tags":[{"paper_doi":"10.1002/art.70297","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"category","value":"Rheumatology","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"condition","value":"Axial Spondyloarthritis","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"condition","value":"Cancer","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"condition","value":"Psoriatic Arthritis","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"condition","value":"Spondyloarthritis","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"modality","value":"IL-12/23 Inhibitor","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"modality","value":"IL-17 Inhibitor","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"modality","value":"IL-23 Inhibitor","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"modality","value":"JAK Inhibitor","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"modality","value":"TNF Inhibitor","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"sample_size","value":"n=56591","value_numeric":56591},{"paper_doi":"10.1002/art.70297","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"study_design","value":"Nationwide Cohort Study","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"warning","value":"Causal inference relies on inverse probability weighting from claims data; unmeasured confounders (e.g., disease severity, concomitant medications) may not be fully accounted for.","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"warning","value":"The protective signal for hematological malignancies (wHR 0.65) is based on only 116 events, so this estimate should be interpreted cautiously — wide confidence intervals reflect limited precision.","value_numeric":null},{"paper_doi":"10.1002/art.70297","tag_type":"warning","value":"The study pools multiple SpA subtypes and multiple drug classes (TNFi, IL-17i, IL-12/23i, IL-23i, JAKi) into a single exposure variable; drug-class-specific or subtype-specific cancer risks may differ and are not fully delineated in the abstract.","value_numeric":null}],"summaries":{"what_studied":"This nationwide French cohort study examined whether duration of targeted therapy exposure (TNFi, IL-17i, IL-12/23i, IL-23i, JAKi) affects cancer risk in 56,591 adults with spondyloarthritis (including psoriatic arthritis and axial SpA), followed for a median of 5.0 years (2014–2024).","key_result":"Exposure >6 months/year vs. ≤6 months/year was associated with a **lower** overall cancer risk (wHR 0.86, 95% CI 0.75–0.99), driven primarily by hematological malignancies (wHR 0.65, 95% CI 0.42–0.99); no significant reduction was seen for solid cancers (wHR 0.92, 95% CI 0.79–1.07). Of 1,224 total cancers, 1,029 were solid and 116 hematological. Cumulative multi-year exposure was not associated with cancer risk.","limitations":"- **Observational design**: residual confounding cannot be excluded despite inverse probability weighting.\n- **Database-based exposure**: therapy adherence is inferred from insurance claims, not directly measured.\n- **Heterogeneous SpA subtypes**: pooling psoriatic arthritis, axial SpA, and other subtypes may obscure subgroup-specific risks.","practice_takeaway":"Clinicians can reassure patients with SpA that prolonged targeted therapy use is not associated with increased cancer risk — and may even lower hematological malignancy risk. Cumulative years of exposure should not, on its own, prompt treatment discontinuation over cancer concerns."}},{"doi":"10.1016/j.cgh.2026.07.020","pmid":"42562116","title":"Superior Effectiveness of Upadacitinib Over Tofacitinib and Ustekinumab in Bio-Exposed Ulcerative Colitis: The TRIDENT-UC Study","journal_title":"Clinical Gastroenterology and Hepatology","journal_issn":"1542-3565","published_at":"2026-08-07T00:00:00.000Z","url":"https://doi.org/10.1016/j.cgh.2026.07.020","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-14T13:24:53.592Z","updated_at":"2026-08-14T13:24:53.592Z","tags":[{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"brand","value":"Rinvoq","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"brand","value":"Stelara","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"brand","value":"Xeljanz","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"condition","value":"Ulcerative Colitis","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"generic","value":"tofacitinib","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"generic","value":"upadacitinib","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"generic","value":"ustekinumab","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"modality","value":"IL-12/23 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"modality","value":"JAK Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"sample_size","value":"n=312","value_numeric":312},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"warning","value":"The mean age at diagnosis (32.6 years) is reported, but the age range of enrolled patients is not provided, limiting age-group precision beyond 'adult'.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously — this is a retrospective observational study with IPTW adjustment, not a head-to-head RCT; residual confounding cannot be excluded.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"warning","value":"Tofacitinib subgroup (n=74) is notably smaller than ustekinumab (n=135) and upadacitinib (n=103), which may affect the stability of IPTW-weighted estimates for that arm.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.07.020","tag_type":"warning","value":"Ustekinumab is not FDA-approved specifically for UC in the same manner as for Crohn's disease; its use in this context may reflect off-label or region-specific prescribing practices.","value_numeric":null}],"summaries":{"what_studied":"Retrospective multicenter study (9 centers, n=312) comparing upadacitinib, tofacitinib, and ustekinumab in bio-exposed UC patients who had failed ≥1 advanced therapy, assessed at weeks 16 and 52 for steroid-free clinical remission (SFCR) and endoscopic remission.","key_result":"After propensity score-weighted analysis, upadacitinib had higher SFCR odds vs. tofacitinib (w16: OR 2.56; w52: OR 3.14) and ustekinumab (w16: OR 3.71; w52: OR 4.68). Endoscopic remission rates at w52 were 56.8% (upadacitinib) vs. 32.7% (tofacitinib) vs. 22.5% (ustekinumab), with upadacitinib outperforming both at both timepoints.","limitations":"Retrospective design with inherent selection bias; IPTW mitigates but does not eliminate confounding; single-country or limited-center generalizability not specified, and small subgroup sizes (tofacitinib n=74) may limit precision of estimates.","practice_takeaway":"In UC patients who have failed a prior biologic, upadacitinib achieves meaningfully higher rates of steroid-free clinical and endoscopic remission than either tofacitinib or ustekinumab at both 16 and 52 weeks. Clinicians should prioritize upadacitinib when selecting a second-line advanced therapy in this population."}},{"doi":"10.1093/ibd/izag142","pmid":"42520305","title":"Risk of serious infection, myocardial infarction, stroke, and thromboembolic events in patients in the United States with ulcerative colitis treated with tofacitinib compared with biologic treatments","journal_title":"Inflammatory Bowel Diseases","journal_issn":"1078-0998","published_at":"2026-07-28T00:00:00.000Z","url":"https://doi.org/10.1093/ibd/izag142","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-04T18:18:01.291Z","updated_at":"2026-08-04T18:18:01.291Z","tags":[{"paper_doi":"10.1093/ibd/izag142","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"brand","value":"Entyvio","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"brand","value":"Stelara","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"brand","value":"Xeljanz","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"condition","value":"Ulcerative Colitis","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"generic","value":"tofacitinib","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"generic","value":"ustekinumab","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"generic","value":"vedolizumab","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"modality","value":"IL-12/23 Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"modality","value":"Integrin Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"modality","value":"JAK Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"modality","value":"TNF Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"sample_size","value":"n=62596","value_numeric":62596},{"paper_doi":"10.1093/ibd/izag142","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"warning","value":"Sample size is the sum of all four treatment groups (5171 + 10424 + 17129 + 29872 = 62596); individual group Ns vary considerably, which may affect power for rare outcomes like MI/stroke.","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"warning","value":"TNF inhibitor brand names were not individually specified in the abstract; no brand tags were added for this class.","value_numeric":null},{"paper_doi":"10.1093/ibd/izag142","tag_type":"warning","value":"Tofacitinib initiators were markedly more biologic-experienced than biologic initiators at baseline; sIPTW adjustment was applied but residual confounding by indication is likely. Interpret hazard ratios with caution.","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study used US claims data (Komodo Health) to compare risks of serious infection, MI, stroke, and VTE among UC patients initiating tofacitinib, ustekinumab, vedolizumab, or TNF inhibitors between May 2018 and September 2022, with a mean follow-up of ~359 days.","key_result":"No significant risk differences were found between tofacitinib and any biologic. Serious infection IRs/100 PY were 2.62 (tofacitinib), 2.73 (ustekinumab), 2.45 (vedolizumab), and 3.25 (TNFi). MI/stroke IRs/100 PY were 0.13, 0.17, 0.17, and 0.19; VTE IRs/100 PY were 0.17, 0.16, 0.23, and 0.33, respectively.","limitations":"- Tofacitinib initiators were more biologic-experienced at baseline (46.3% had ≥2 prior biologics vs 7.5%–33.7% for biologics), indicating channeling bias that sIPTW adjustment may not fully correct.\n- Mean follow-up of ~359 days may miss long-term safety signals.\n- Claims data cannot capture unmeasured confounders (e.g., disease severity, smoking status).","practice_takeaway":"In a large US real-world population with UC, tofacitinib showed no significantly higher risk of serious infection, MI, stroke, or VTE compared with ustekinumab, vedolizumab, or TNF inhibitors. Clinicians can factor these data into shared decision-making, particularly for biologic-experienced patients weighing tofacitinib."}},{"doi":"10.1016/j.ard.2026.06.017","pmid":"42431784","title":"Cancer risk of Janus kinase inhibitors and other advanced therapies in immune-mediated inflammatory diseases: a systematic review and Bayesian network meta-analysis of RCTs","journal_title":"Annals of the Rheumatic Diseases","journal_issn":"0003-4967","published_at":"2026-07-10T00:00:00.000Z","url":"https://doi.org/10.1016/j.ard.2026.06.017","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-23T13:33:19.238Z","updated_at":"2026-07-23T13:33:19.238Z","tags":[{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"category","value":"Rheumatology","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"condition","value":"Inflammatory Bowel Disease","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"condition","value":"Psoriasis","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"condition","value":"Psoriatic Arthritis","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"condition","value":"Rheumatoid Arthritis","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"generic","value":"tofacitinib","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"modality","value":"CD20 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"modality","value":"CTLA-4 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"modality","value":"IL-12/23 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"modality","value":"IL-17 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"modality","value":"IL-23 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"modality","value":"IL-6 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"modality","value":"JAK Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"modality","value":"TNF Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"sample_size","value":"n=164824","value_numeric":164824},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"study_design","value":"Systematic Review and Network Meta-Analysis","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"warning","value":"Class-level pooling of JAK inhibitors may mask agent-specific or dose-specific differences; individual drug comparisons are not reported.","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"warning","value":"Long-term extension studies are included alongside RCTs, which may introduce exposure-time bias favoring detection of malignancy in longer studies.","value_numeric":null},{"paper_doi":"10.1016/j.ard.2026.06.017","tag_type":"warning","value":"The absolute risk calculations depend on assumed baseline cancer incidence rates for 'standard-risk' vs 'higher-risk' populations, which are not fully specified in the abstract—clinicians should interpret absolute numbers cautiously without the full paper.","value_numeric":null}],"summaries":{"what_studied":"This systematic review and Bayesian network meta-analysis evaluated relative and absolute cancer risk of JAK inhibitors (JAKis) vs other advanced therapies (TNFi, IL-6, IL-17, IL-23, IL-12/23, CTLA-4, CD20 inhibitors) across immune-mediated inflammatory diseases (RA, PsO/PsA, IBD) using 305 RCTs and long-term extension studies (164,824 participants; 264,100 person-years exposure) published up to February 2026.","key_result":"JAKis were associated with higher malignancy risk than TNFi (RR 1.60; 95% CrI 1.27–2.02) and standard care (RR 1.85; 95% CrI 1.38–2.47) across all three disease areas. Absolute excess risk vs TNFi was negligible in standard-risk patients (~1 extra cancer per 27,000 person-years) but clinically meaningful in high-risk patients (~1 extra cancer per 147 person-years). IL-6, IL-17, IL-23, IL-12/23, CTLA-4, and CD20 inhibitors showed cancer risks broadly comparable to TNFi.","limitations":"- Relies on RCT and long-term extension data, which may underrepresent older or higher-risk patients seen in routine care.\n- Class-level pooling may obscure differences between individual JAKi agents or doses.\n- Malignancy outcomes (including non-melanoma skin cancer) vary in ascertainment and reporting across trials.","practice_takeaway":"Clinicians should apply risk-stratified decision-making when prescribing JAKis across all IMIDs—not just RA—particularly in patients with prior malignancy or other cancer risk factors. For standard-risk patients the absolute excess risk vs TNFi is very small, but it becomes meaningful in higher-risk populations (~1 extra cancer per 147 person-years)."}},{"doi":"10.1016/j.cgh.2026.06.003","pmid":"42269996","title":"Risk of lymphoma associated with biologics and immunosuppressants in inflammatory bowel disease patients: a nationwide nested case-control study","journal_title":"Clinical Gastroenterology and Hepatology","journal_issn":"1542-3565","published_at":"2026-06-11T00:00:00.000Z","url":"https://doi.org/10.1016/j.cgh.2026.06.003","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-17T13:29:46.577Z","updated_at":"2026-06-17T13:29:46.577Z","tags":[{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"brand","value":"Entyvio","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"brand","value":"Stelara","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"condition","value":"Crohn's Disease","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"condition","value":"Inflammatory Bowel Disease","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"condition","value":"Lymphoma","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"condition","value":"Ulcerative Colitis","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"generic","value":"azathioprine","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"generic","value":"methotrexate","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"generic","value":"ustekinumab","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"generic","value":"vedolizumab","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"modality","value":"IL-12/23 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"modality","value":"Integrin Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"modality","value":"JAK Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"modality","value":"Thiopurine","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"modality","value":"TNF Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"sample_size","value":"n=422793","value_numeric":422793},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"study_design","value":"Nested Case-Control Study","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"warning","value":"Crohn's disease and ulcerative colitis are not explicitly broken out as separate conditions in the abstract; they are inferred as the IBD subtypes studied.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"warning","value":"JAK inhibitor exposure details (specific agents, duration) are not described in the abstract, limiting interpretation of the null finding for that class.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"warning","value":"Methotrexate's lymphoma association was flagged as inconsistent across sensitivity analyses — tag for this drug should be interpreted with caution.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.06.003","tag_type":"warning","value":"The paper's DOI and publication date (June 11, 2026) are in the future relative to standard indexing; content appears to be an advance publication — conclusions should be treated as preliminary until final peer-reviewed version is confirmed.","value_numeric":null}],"summaries":{"what_studied":"This nationwide nested case-control study evaluated lymphoma risk associated with IBD treatments — thiopurines, methotrexate, anti-TNF agents, vedolizumab, ustekinumab, and JAK inhibitors — in 422,793 IBD patients from the French National Health Data System (SNDS) between 2009 and 2024, with 1,238 lymphoma cases matched to 52,565 controls.","key_result":"Current thiopurine use nearly doubled lymphoma risk (aOR 2.36, 95% CI 2.00–2.79) and anti-TNF use raised it by 72% (aOR 1.72, 95% CI 1.45–2.05); their combination more than tripled risk (aOR 3.44, 95% CI 2.62–4.51). Vedolizumab, ustekinumab, and JAK inhibitors showed no increased lymphoma risk.","limitations":"Methotrexate's association with lymphoma was inconsistent across sensitivity analyses, limiting firm conclusions. As a claims-based study, residual confounding by disease severity or unmeasured factors cannot be excluded. Exposure to newer agents (vedolizumab, ustekinumab, JAKi) may be underrepresented, limiting power for those comparisons.","practice_takeaway":"When choosing maintenance therapy for IBD, clinicians should weigh the clear lymphoma risk of thiopurines and anti-TNF — especially in combination — against the reassuring safety profile of vedolizumab, ustekinumab, and JAK inhibitors. Elevated risk from thiopurines may persist up to 3 years after stopping, so post-discontinuation vigilance is warranted."}},{"doi":"10.1007/s13555-026-01761-7","pmid":"42068460","title":"A Narrative Review: Do Systemic Drugs Used in the Treatment of Psoriatic Disease Affect Alzheimer’s Disease?","journal_title":"Dermatology and Therapy","journal_issn":"2193-8210","published_at":"2026-05-02T00:00:00.000Z","url":"https://doi.org/10.1007/s13555-026-01761-7","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-10T13:20:36.620Z","updated_at":"2026-05-10T13:20:36.620Z","tags":[{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"brand","value":"Cosentyx","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"brand","value":"Enbrel","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"brand","value":"Humira","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"brand","value":"Otezla","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"brand","value":"Remicade","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"brand","value":"Sotyktu","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"brand","value":"Stelara","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"condition","value":"Alzheimer's Disease","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"condition","value":"Dementia","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"condition","value":"Psoriasis","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"condition","value":"Psoriatic Arthritis","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"generic","value":"acitretin","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"generic","value":"adalimumab","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"generic","value":"apremilast","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"generic","value":"cyclosporine","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"generic","value":"deucravacitinib","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"generic","value":"etanercept","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"generic","value":"infliximab","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"generic","value":"methotrexate","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"generic","value":"roflumilast","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"generic","value":"secukinumab","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"generic","value":"tofacitinib","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"generic","value":"upadacitinib","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"generic","value":"ustekinumab","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"modality","value":"Conventional Synthetic DMARD","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"modality","value":"IL-12/23 Inhibitor","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"modality","value":"IL-17 Inhibitor","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"modality","value":"IL-23 Inhibitor","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"modality","value":"JAK Inhibitor","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"modality","value":"NSAID","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"modality","value":"PDE4 Inhibitor","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"modality","value":"Retinoid","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"modality","value":"TNF-Alpha Inhibitor","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"modality","value":"TYK2 Inhibitor","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"warning","value":"Corresponding author (Tsen-Fang Tsai) has disclosed extensive consultant relationships with manufacturers of many drugs discussed in the review.","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"warning","value":"Level of evidence assigned as 5 (narrative review/expert opinion) due to absence of PRISMA methodology, risk-of-bias tools, or meta-analytic synthesis, even though individual cited studies range from Level 1 to Level 5.","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"warning","value":"Several drug-AD associations cited are from studies in rheumatoid arthritis populations, not specifically psoriasis patients; generalizability to psoriatic disease may be limited.","value_numeric":null},{"paper_doi":"10.1007/s13555-026-01761-7","tag_type":"warning","value":"This is a narrative review without formal systematic methods; findings are hypothesis-generating and subject to selection bias in included studies.","value_numeric":null}],"summaries":{"what_studied":"This narrative review examined whether systemic drugs used for psoriatic disease (NSAIDs, methotrexate, cyclosporin, retinoids, PDE4 inhibitors, JAK inhibitors, TYK2 inhibitors, and biologics targeting TNF-α, IL-12/23, IL-17, and IL-23) influence the risk or progression of Alzheimer's disease (AD), using AD as a model for dementia. Literature from PubMed (2015–2025) was synthesized across preclinical, observational, and RCT-level evidence.","key_result":"Most preclinical and observational data suggest antipsoriatic therapies may reduce AD risk. The strongest clinical signal comes from a propensity score–matched cohort (n=1,766) showing biologic therapy for psoriasis was associated with a **53% lower risk of incident dementia** vs. conventional systemic therapy alone. In a large EHR-based study (56 million records), TNF inhibitors (etanercept, adalimumab, infliximab) were linked to markedly reduced AD odds (ORs 0.34, 0.28, and 0.52, respectively; all P<0.0001). However, several large observational studies found the psoriasis–dementia association attenuated or disappeared after adjusting for comorbidities.","limitations":"- Narrative (not systematic) review with no PRISMA flow, risk-of-bias assessment, or quantitative synthesis, limiting reproducibility.\n- Most mechanistic evidence comes from preclinical models (Level 5), with very few adequately powered RCTs in humans.\n- Residual confounding by disease severity, metabolic comorbidities, and medication use cannot be excluded in observational studies.","practice_takeaway":"For older patients with psoriasis, consider early cognitive screening, as shared inflammatory mechanisms may raise dementia risk—especially in those with metabolic comorbidities. Biologic therapy, particularly TNF inhibitors, shows the most consistent signal for possible neuroprotection, but current evidence is hypothesis-generating and should not yet change prescribing solely for dementia prevention."}},{"doi":"10.1016/j.cgh.2026.04.015","pmid":"42055304","title":"Serious infection in inflammatory bowel diseases patients treated with vedolizumab, ustekinumab, JAK inhibitors, anti-TNF or aminosalicylates","journal_title":"Clinical Gastroenterology and Hepatology","journal_issn":"1542-3565","published_at":"2026-04-27T00:00:00.000Z","url":"https://doi.org/10.1016/j.cgh.2026.04.015","source_score":10,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-09T13:22:18.216Z","updated_at":"2026-05-09T13:22:18.216Z","tags":[{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"brand","value":"Entyvio","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"brand","value":"Stelara","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"condition","value":"Crohn's Disease","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"condition","value":"Inflammatory Bowel Disease","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"condition","value":"Serious Infection","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"generic","value":"ustekinumab","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"generic","value":"vedolizumab","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"modality","value":"Aminosalicylate","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"modality","value":"Anti-TNF Agent","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"modality","value":"IL-12/23 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"modality","value":"Integrin Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"modality","value":"JAK Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"sample_size","value":"n=219229","value_numeric":219229},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"warning","value":"JAKi group is substantially smaller (n=6,439) compared to anti-TNF (n=93,444), which may affect precision of estimates.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"warning","value":"Median follow-up of 1.0 year is short; long-term infection risk rankings may differ.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"warning","value":"The study is not yet formally published as of today's date (published 2026-04-27) and the DOI suggests in-press status; findings should be interpreted with that in mind.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.04.015","tag_type":"warning","value":"Vedolizumab showing higher serious infection risk than anti-TNF (aHR 1.07 vs. aminosalicylates 1.38 vs. 1.29) is counterintuitive given its gut-selective mechanism; residual confounding or channeling bias (more complex patients receiving vedolizumab) may explain this finding.","value_numeric":null}],"summaries":{"what_studied":"Nationwide French cohort of 219,229 IBD patients (>15 years) initiating vedolizumab, ustekinumab, JAK inhibitors (JAKi), anti-TNF, or aminosalicylates between 2014–2024, assessed for serious infection risk using propensity score–weighted analysis over a median follow-up of 1.0 year.","key_result":"15,081 serious infections occurred. Versus aminosalicylates: JAKi carried the highest risk (aHR 1.63, 95%CI 1.45–1.84), followed by vedolizumab (aHR 1.38), anti-TNF (aHR 1.29), and ustekinumab (aHR 1.05, essentially no excess risk). Versus anti-TNF: ustekinumab was safest (aHR 0.81), vedolizumab was similar (aHR 1.07), and JAKi was highest (aHR 1.27). Concomitant corticosteroids nearly doubled risk (aHR 2.06).","limitations":"Median follow-up of only 1.0 year limits long-term risk assessment. Residual confounding is possible despite propensity score weighting, as channel bias (sicker patients routed to specific therapies) may persist. Administrative claims data may miss nuanced clinical details (e.g., disease severity, comorbidities).","practice_takeaway":"When choosing advanced IBD therapy, ustekinumab carries the lowest serious infection risk, while JAKi carries the highest — especially for herpesvirus infections; ensure vaccination and minimize concomitant corticosteroids where possible. Anti-TNF users should be monitored closely for mycobacterial infections, and JAKi users for herpesvirus reactivation."}},{"doi":"10.1016/j.cgh.2026.01.017","pmid":"41616901","title":"Ustekinumab and Janus Kinase Inhibitors Outperform Vedolizumab as Second-Line Therapy in Anti-Tumor Necrosis Factor-Experienced Patients With Ulcerative Colitis","journal_title":"Clinical Gastroenterology and Hepatology","journal_issn":"1542-3565","published_at":"2026-01-29T00:00:00.000Z","url":"https://doi.org/10.1016/j.cgh.2026.01.017","source_score":18,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-27T06:17:02.218Z","updated_at":"2026-08-27T06:17:02.218Z","tags":[{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"brand","value":"Entyvio","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"brand","value":"Remicade","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"brand","value":"Stelara","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"condition","value":"Ulcerative Colitis","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"generic","value":"infliximab","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"generic","value":"ustekinumab","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"generic","value":"vedolizumab","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"modality","value":"IL-12/23 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"modality","value":"Integrin Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"modality","value":"JAK Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"sample_size","value":"n=596","value_numeric":596},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"warning","value":"Full text was not available; key details such as specific JAK inhibitors used, breakdown of adverse event types, and exact steroid-free remission rates (percentages) could not be verified.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"warning","value":"Retrospective design with energy balancing weights used to address confounding — residual confounding cannot be excluded.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"warning","value":"Study registered on ClinicalTrials.gov (NCT06691061) but published in 2026; trial registration date relative to data collection is unclear.","value_numeric":null},{"paper_doi":"10.1016/j.cgh.2026.01.017","tag_type":"warning","value":"Ustekinumab is not FDA-approved for ulcerative colitis (only Crohn's disease); its use in UC in this study reflects European real-world practice and may not apply in all regions.","value_numeric":null}],"summaries":{"what_studied":"This retrospective, multicenter European study compared the real-world effectiveness and safety of vedolizumab, ustekinumab, and JAK inhibitors as second-line therapy in 596 adults with ulcerative colitis (UC) who had previously failed anti-TNF-α therapy, over 12 months.","key_result":"Both ustekinumab and JAKi were superior to vedolizumab for steroid-free clinical remission (aHR 1.54 and 1.66, respectively) and biochemical SFCR (aHR 2.26 and 3.37, respectively) at 12 months, with no significant difference between ustekinumab and JAKi. 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From Weeks 12 to 28, PASI responses with tildrakizumab increased from 60.77%→81.84% (PASI 75), 38.54%→71.23% (PASI 90), and 6.97%→22.64% (PASI 100); by Week 28, efficacy was comparable to TNFα, IL-17, IL-12/23, and other IL-23 inhibitors.","practice_takeaway":"For Asian adults starting tildrakizumab, expect slower early clearance by 12 weeks but marked gains by 28 weeks, reaching parity with other biologics. Its sustained improvement and low dosing frequency support it as an effective option for moderate-to-severe plaque psoriasis."}},{"doi":"10.1001/jamadermatol.2025.2714","pmid":"40768223","title":"Biopharmaceutical Switching in Psoriasis Treatment","journal_title":"JAMA Dermatology","journal_issn":"2168-6068","published_at":"2025-08-06T00:00:00.000Z","url":"https://doi.org/10.1001/jamadermatol.2025.2714","source_score":82,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2025-10-19","doi":"10.1001/jamadermatol.2025.2714","days":"30","issn":"2168-6068","rank":"6","field":"Clinical Medicine","score":"82","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1001/jamadermatol.2025.2714","title":"Biopharmaceutical Switching in Psoriasis Treatment: A Systematic Review and Meta-Analysis.","journal":"JAMA dermatology","methods":"","results":"Twenty-four RCTs involving 12 661 patients with psoriasis and 8 switching categories were analyzed. Significant differences observed in PASI 90 between week 4 and week 0 (odds ratio [OR], 6.53; 95% CI, 2.58-16.51). Substantial disparities were noted across various PASI response metrics, specifically PASI 90 (OR, 28.61; 95% CI, 12.89-63.47), PASI 75 (OR, 11.11; 95% CI, 5.95-20.75), and PASI 100 (OR, 18.76; 95% CI, 8.37-42.01). No difference exists in safety outcomes between the end point and week 0, including in serious AEs (OR, 1.63; 95% CI, 0.72-3.69), severe AEs (OR, 1.40; 95% CI, 0.61-3.26), and treatment-related AEs (OR, 1.79; 95% CI, 0.41-7.88). The highest risk of infection was associated with switching from anti-TNF-α agents to anti-interleukin (IL)-23p19, anti-IL-17A, or anti-IL-12/23p40 agents, with infection rates of 0.62%, 0.54% and 0.39%, respectively.","abstract":"$34","keywords":[],"pubmed_id":"40768223","conclusions":"","publication_date":"2025-08-06T00:00:00"},"crossref":{"DOI":"10.1001/jamadermatol.2025.2714","URL":"https://doi.org/10.1001/jamadermatol.2025.2714","ISSN":["2168-6068"],"link":[{"URL":"https://jamanetwork.com/journals/jamadermatology/articlepdf/2837167/jamadermatology_zhang_2025_oi_250038_1760475172.18406.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"1029","type":"journal-article","issue":"10","score":1,"title":["Biopharmaceutical Switching in Psoriasis Treatment"],"author":[{"given":"Miao","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and 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China"}]},{"given":"Yaqiong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China"}]},{"given":"Ying","family":"Luo","sequence":"additional","affiliation":[{"name":"Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China"}]},{"given":"Liu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China"},{"name":"Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China"}]},{"given":"Jiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China"},{"name":"Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China"}]},{"given":"Chunxiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China"},{"name":"Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China"}]},{"given":"Naixuan","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China"},{"name":"Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China"}]},{"given":"Juntang","family":"Yan","sequence":"additional","affiliation":[{"name":"School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 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Time on methotrexate, other older systemics, anti‑TNF biologics, other biologics (targeting IL‑12, IL‑23, IL‑17), and tofacitinib was compared with time off those drugs for risk of hospitalization for infection.","key_result":"Among 11,641 patients (53% female; median age 71), 1,967 serious infections occurred over a median 4.8 years. Infection rates per 100 person‑years were 2.7 (methotrexate), 2.5 (other older systemics), 2.2 (anti‑TNF), 1.4 (other biologics), and 8.9 (tofacitinib); adjusted RRs vs nonuse of each category were 0.95 (95% CI, 0.85–1.07), 0.92 (0.79–1.07), 0.87 (0.69–1.10), 0.65 (0.48–0.88), and 2.89 (1.14–7.34), respectively.","limitations":"Comparators were person‑time not using each category, not direct head‑to‑head between classes. 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Screening was measured within 6 months before and up to 2 years after treatment start.","key_result":"Before initiation, CBC testing occurred in 41% (3161/7787) to 69% (19,659/28,684); TB screening in 11% (889/7787) to 59% (3613/6116), with 1‑year retesting in 3% (149/4577) to 26% (1559/6097); hepatitis panels in 13% (1006/7787) to 41% (16,728/40,965). Apremilast and dupilumab showed low pretreatment testing (apremilast 15% [2331/16,116] to 45% [7253/16,116]; dupilumab 11% [850/7787] to 41% [3161/7787]) that persisted at 1 year (apremilast 9% [816/8496] to 36% [2999/8496]; dupilumab 3% [149/4577] to 25% [1160/4577]).","practice_takeaway":"Fewer than 60% of patients starting systemic immunomodulators received recommended baseline tests. Clinicians should verify TB and hepatitis screening and needed labs by agent (notably TNF/IL inhibitors and methotrexate) and note that 1‑year TB retesting was uncommon (3%‑26%)."}},{"doi":"10.1001/jamadermatol.2023.4846","pmid":"38055239","title":"Risk of Paradoxical Eczema in Patients Receiving Biologics for Psoriasis","journal_title":"JAMA Dermatology","journal_issn":"2168-6068","published_at":"2023-12-06T00:00:00.000Z","url":"https://doi.org/10.1001/jamadermatol.2023.4846","source_score":74,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2024-01-28","doi":"10.1001/jamadermatol.2023.4846","days":"30","issn":"2168-6068","rank":"5","field":"Clinical Medicine","score":"74","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1001/jamadermatol.2023.4846","title":"Risk of Paradoxical Eczema in Patients Receiving Biologics for Psoriasis.","journal":"JAMA dermatology","methods":"","results":"$3b","abstract":"$3c","keywords":[],"pubmed_id":"38055239","conclusions":"","publication_date":"2023-12-06T00:00:00"},"crossref":{"DOI":"10.1001/jamadermatol.2023.4846","URL":"https://doi.org/10.1001/jamadermatol.2023.4846","ISSN":["2168-6068"],"link":[{"URL":"https://jamanetwork.com/journals/jamadermatology/articlepdf/2812208/jamadermatology_aljanabi_2023_oi_230059_1705092722.29074.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"71","type":"journal-article","issue":"1","score":1,"title":["Risk of Paradoxical Eczema in Patients Receiving Biologics for Psoriasis"],"author":[{"given":"Ali","family":"Al-Janabi","sequence":"first","affiliation":[{"name":"Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom"},{"name":"Dermatology Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom"}]},{"given":"Oras A.","family":"Alabas","sequence":"additional","affiliation":[{"name":"Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom"}]},{"given":"Zenas Z. 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Inhibitor","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.4846","tag_type":"sample_size","value":"n=24,997","value_numeric":24997},{"paper_doi":"10.1001/jamadermatol.2023.4846","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.4846","tag_type":"study_design","value":"Prospective Cohort","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.4846","tag_type":"warning","value":"Incidence units reported as per 100,000 person-years seem unexpectedly low given 273 events over 81,441 patient-years; verify in full text.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2023.4846","tag_type":"warning","value":"The unit of analysis was drug exposures rather than patients, which may affect patient-level interpretation.","value_numeric":null}],"summaries":{"what_studied":"A prospective cohort from the UK/Ireland BADBIR registry evaluated adults with plaque psoriasis treated with biologics (TNF, IL-17, IL‑12/23, IL‑23) between 2007 and 2022 to compare paradoxical eczema risk. The analysis included 24,997 drug exposures from 13,699 participants over 81,441 patient-years using propensity score–weighted Cox models.","key_result":"Paradoxical eczema occurred in 273 exposures (1%). Adjusted incidence rates were 1.22, 0.94, 0.80, and 0.56 per 100,000 person-years for IL‑17, TNF, IL‑12/23, and IL‑23 inhibitors, respectively; versus TNF, IL‑23 inhibitors had lower risk (HR 0.39; 95% CI 0.19‑0.81), while IL‑17 (HR 1.03; 0.74‑1.42) and IL‑12/23 (HR 0.87; 0.66‑1.16) showed no difference. Higher risk was associated with increasing age (HR 1.02 per year; 1.01‑1.03), prior atopic dermatitis (HR 12.40; 6.97‑22.06) or hay fever (HR 3.78; 1.49‑9.53); males had lower risk (HR 0.60; 0.45‑0.78).","practice_takeaway":"Paradoxical eczema was rare in biologic-treated psoriasis, with the lowest observed risk on IL‑23 inhibitors. Screen for personal history of atopic dermatitis or hay fever and consider age and sex when counseling about this risk."}}],"initialOffset":19,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"IL-12/23 Inhibitor"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"IL-12/23 Inhibitor"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"IL-12/23 Inhibitor"}}}]]

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