Psoriasis and Seronegative Spondyloarthropathy in Atopic Dermatitis Patients Treated with Dupilumab or Tralokinumab: A Multicentre Observational Study

Background: Biologic therapies such as dupilumab and tralokinumab have highly impacted on the management of moderate-to-severe atopic dermatitis (AD). However, recent clinical observations reported paradoxical adverse events (AEs), including psoriasis and seronegative spondyloarthropathy (SpA). Objective: To assess the incidence, clinical characteristics, and management of psoriasis and SpA, in AD patients treated with dupilumab or tralokinumab in a real-world setting. Methods: We conducted a multicentre retrospective observational study involving AD patients receiving dupilumab or tralokinumab for at least 16 weeks between January 2019 and May 2025. Data were collected on patients developing psoriasis and/or SpA, including demographics, time to onset, severity, management strategies, and treatment outcomes. Results: Psoriasis developed in 78/5899 patients (1.32%) receiving dupilumab and 16/769 (2.08%) on tralokinumab, with a mean time to onset of 57.7 ± 66.5 and 28.3 ± 28.9 weeks, respectively. SpA occurred in 17 patients (0.29%) on dupilumab and 1 (0.13%) on tralokinumab. Topical calcipotriol/betamethasone was the most frequent treatment for psoriasis, while systemic agents, including methotrexate and corticosteroids, were required in refractory cases. In addition, a proportion of patients required switching to alternative biologics due to poor disease control. For SpA, management often involved systemic corticosteroids, NSAIDs, or methotrexate, and upadacitinib was introduced in 41% of dupilumab cases requiring therapeutic escalation. Conclusion: Though rarely, psoriasis and SpA are AEs emerging during dupilumab or tralokinumab therapy in AD patients. Close monitoring and prompt differential diagnosis is essential to optimize patient outcomes.