Incidence and Risk Factors of Treatment-Emergent Eczematous Reactions in Patients with Psoriasis Treated with Biologics: A Systematic Review and Meta-Analysis
In brief
Eczema reactions affected 3.5% on IL-17 drugs and 0.1% on IL-23 drugs
Across 26 studies and 34,511 exposures, new or worsening eczema occurred in 2.17% of patients receiving biologics for psoriasis. Pooled rates were highest with IL-17 inhibitors and lowest with IL-23 inhibitors; a history of atopic dermatitis was strongly associated with reactions. Rates also varied by dose and study population, so individual risk remains uncertain.
- Journal
- BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy (Q1)
- Published
- 16 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Yifei Feng, Yan Lu
- PMID
- 42886333
- DOI
- 10.1007/s40259-026-00809-6
Why clinicians should know about it
- Picked for Dermatology (paper of the day, 17 October 2026): Incidence and risk factors of eczematous reactions
Abstract
BACKGROUND AND OBJECTIVE: Treatment-emergent eczematous reactions have been reported in patients with psoriasis receiving biologic therapies, but their pooled incidence and associated factors remain unclear. We aimed to estimate the incidence and associated factors for treatment-emergent eczematous reactions in biologic-treated psoriasis patients. METHODS: We searched PubMed, EMBASE, and Web of Science (to Jan 2026) for studies reporting new-onset or exacerbated eczema in psoriasis patients treated with tumor necrosis factor (TNF), interleukin-17 (IL-17), interleukin-12/23 (IL-12/23), or IL-23 inhibitors. Two eligible studies of the oral tyrosine kinase 2 (TYK2) inhibitor deucravacitinib were analyzed separately as an exploratory subgroup. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, data were synthesized using a random-effects model with Freeman-Tukey double arcsine transformation. The primary outcome was the pooled incidence of treatment-emergent eczematous reactions. Secondary analyses examined differences according to biologic class, dosage, and demographic characteristics. RESULTS: Analysis of 26 publications (34,511 exposures) showed a 2.17% overall incidence (95% CI 1.57-2.85). Pooled incidence differed by class (p < 0.001): IL-17 inhibitors had the highest incidence (3.47%; 95% CI 2.34-4.77), followed by IL-12/23 (2.15%; 95% CI 0.04-6.59) and TNF inhibitors (1.02%; 95% CI 0.83-1.23), and IL-23 inhibitors had the lowest (0.09%; 95% CI 0.00-0.71). Within the IL-17 class, pooled incidence was higher with secukinumab (5.3%; 95% CI 2.95-8.2) than with ixekizumab (1.51%; 95% CI 0.41-3.1). High-dose regimens were associated with a higher pooled incidence than low-dose regimens (7.65% vs 3.36%; p = 0.03). Incidence was higher in studies conducted in East Asian populations (~ 6%) than in Western populations (~ 1%). A history of atopic dermatitis showed the strongest patient-level association with treatment-emergent eczematous reactions (hazard ratio, 12.40; 95% CI 6.97-22.06). CONCLUSIONS: Eczematous reactions in biologic-treated psoriasis were associated with biologic class, dose, and study population, with the highest incidences for IL-17 inhibitors, high-dose regimens, and studies of East Asian populations.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.