Ohio AG approves sale of Summa Health to General Catalyst's HATCo, with some conditions

 Ohio Attorney General Dave Yost gave the greenlight for General Catalyst subsidiary Health Assurance Transformation Company to move ahead with its acquisition of Summa Health, but with a list of 10 conditions.

Venture capital firm General Catalyst made waves in October 2023 when it announced the launch of HATCo to provide advisory services to health systems with ambitions to buy a hospital system. Three months later, General Catalyst announced its intent to acquire Akron, Ohio-based Summa Health.

In November, HATCo announced it signed a definitive agreement to buy Summa Health for $485 million.

The purchase price, when added to Summa Health’s current cash, will enable the health system to eliminate $850 million in existing debt, according to the organizations.

Akron-based Summa Health is among Ohio’s largest integrated healthcare delivery systems with two acute care hospital campuses, 15 community medical centers, a rehab hospital, a health insurance arm, a multispecialty group practice and a research and medical education program. It employs more than 8,000 people, and reported almost $1.9 billion in total revenues and an $8 million operating loss in 2024.

In releases and blog posts, General Catalyst has characterized the purchase as “not a quick flip but a long-term commitment to transformation that benefits the community”—an effort to distance the transaction from private equity hospital purchases that critics say cripple hospitals in pursuit of quickly extracting value. 

Because the sale involves the transfer of nonprofit assets from the health system to a for-profit entity, the Attorney General’s Office — as the agency charged under Ohio law with protecting charitable assets — is statutorily responsible for approving or denying the sale.

“My role in this process is to protect Ohio’s charities,” Yost said in a press release. “After a comprehensive review by the Charitable Law Section of my office, we’re confident that the agreement includes enforceable commitments that will secure Summa’s nonprofit mission, protect patient care, and ensure continued investment in the greater Akron community.

“With proper safeguards in place, this has the potential to strengthen health care in northeastern Ohio for years to come.”

After being notified in November 2024 of the proposed sale, the Charitable Law Section assessed whether the parties are in compliance with fiduciary duties, whether the nonprofit will receive full and fair market value, and whether the proceeds will be used in a manner consistent with Summa Health’s original charitable purpose.

Yost’s office approved the sale provided that HATCo and Summa Health meet 10 conditions, including increasing the sale price by $15 million, according to a letter sent to both organizations. 

The conditional approval requires the transfer of an additional $15 million in cash, with another $15 million in equity to be transferred to Summa's existing nonprofit foundation to "benefit people who are served by the system in Summit County and surrounding areas," the AG's office said.

Yost's office wants changes to ensure sale proceeds will carry on the charitable purpose of supporting the health of the community, and that make certain that the new owner honors its promises to continue operating Summa’s healthcare operations, according to the letter.

The other conditions require that the charitable purpose of the foundation receiving the proceeds of the sale be consistent with Summa’s original charitable purpose and the majority of the foundation’s board members have no affiliation with Summa Health.

For three years after closing, the Foundation will agree not to sell its $15 million equity interest, according to the conditions. The Ohio Attorney General will retain for 10 years the jurisdiction to enforce HATCo’s ongoing obligations to the hospital system.

HATCo also will agree to cooperate with any future Attorney General investigation.

And, for 10 years after the sale’s closing, HATCo will provide the Attorney General a copy of an annual report outlining its compliance with its post-closing obligations. During that same period, HATCo will notify the Attorney General of certain transactions that could trigger antitrust concerns, as outlined in the sale conditions.

With the sale now approved, the organizations must provide notice and conduct a public hearing within 45 days to field comments on the proposed use of the proceeds, according to the AG's Office.

The proposed acquisition deal is getting pushback from local advocates who want state officials to impose stronger checks on the deal’s price tag and impact on local care.

In April, members of Summa Is Not For Sale, which describes itself as “a coalition of concerned Ohio residents,” wrote to the state AG asking Yost's office to investigate the deal and demand assurances from General Catalyst and Summa before giving it the go ahead.

One key concern for Summa Is Not For Sale highlighted in Friday’s letter is the deal’s $485 million price tag, which is based on General Catalyst’s assessment of fair market value.

The letter’s authors—Matthew Charlebois and David Guran, both affiliated with the group—said that number “appears to reflect only the hospital’s debt and not the enterprise value of the organization or its substantial net assets.” Publicly available filings show the system’s net assets to be nearly $970 million, while its total liabilities land at just over $1 billion.

In a statement issued on Wednesday, Summa Is Not For Sale coalition member Jeff Barge, a Cleveland resident, said Ohio AG Yost made a number of important improvements to this deal, including a $30 million increase in the sale price.

"We're pleased that the Akron community will continue to hold an equity position in Summa Health for at least the next three years, even if it is just 3 percent. That means the new community foundation will have access to all financial reports to ensure that all conditions of the sale are met and public health is being improved,” Barge said.

The coalition continues to believe that the true market value of Summa Health exceeds $800 million, the organization said.

https://www.fiercehealthcare.com/providers/ohio-ag-approves-sale-summa-health-general-catalysts-hatco-some-conditions

Waste Of The Day: Unused COVID Quarantine Pods

 by Jeremy Portnoy via RealClearInvestigations,

Topline: Nashville spent $1.2 million to buy 108 quarantine housing pods in 2021 during the Covid-19 pandemic, but the shelters were never used. Now the city plans to give 25 of them away to local nonprofits to be used as homeless shelters while covering the cost of renovating them.

Key facts: The combined municipality of Metropolitan Government of Nashville and Davidson County bought the pods using federal funds from the Centers for Disease Control and Prevention. Part of the $1.2 million price tag was for certified nursing assistants and 24-hour security at the pods — which was obviously unnecessary because the pods were never used, Nashville Scene reported.

Nashville started installing 25 of the quarantine pods in 2021 but could not use them until the Tennessee Fire Marshall’s Office gave its approval. The fire marshal told Nashville Scene they required a letter signed by an engineer declaring the pods were safe, but Nashville did not send the letter for almost a year.

The remaining 86 pods have been in storage in an unknown location. The Nashville Scene could not even confirm whether the pods are still in Tennessee.

Metro Nashville has been trying to find a way to repurpose the pods since 2023 and is currently accepting applications to give away the pods for homeless housing. The government will pay for the cost of transporting the pods, renovating them, buying replacement parts and installing thermal barriers.

Critics say the city is taking too long to put the pods into use, which were approved for use as homeless shelters in late 2024. Dede Byrd, a founding member of local nonprofit Reclaim Brookmeade Park, told FOX17 Nashville “It is unacceptable to me that it takes this long.”

Summary: Covid-related expenses cost the country more than enough without spending money on initiatives that did not even prevent the spread of disease, like Nashville’s unused quarantine pods.

The #WasteOfTheDay is brought to you by the forensic auditors at OpenTheBooks.com

https://www.zerohedge.com/political/waste-day-unused-covid-quarantine-pods

Homeowners Worried About Chemicals Being Spread In Sewage Fertilizer

 by Michael Clements via The Epoch Times (emphasis ours),

Rural landowners say America’s farms have become dumping grounds for sludge from the wastewater treatment plants of larger cities. They complain of foul odors, contaminated soil, health problems, and stormwater runoff contaminating streams, lakes, and groundwater with possibly dangerous chemicals.

A tractor spreads fertilizer on a field at a farm in Church Hill, Md., on March 20, 2025. Biosolids, or treated sewage sludge, are widely used in the United States as a soil amendment and fertilizer. But rural landowners and farmers are increasingly concerned about foul odors, soil contamination, health risks, and stormwater runoff carrying potentially dangerous chemicals into waterways. Jim Watson/AFP via Getty Images

The treated sewage sludge—known as “biosolids”— is the solid matter left from the wastewater treatment process. The sludge is removed from the bottom of the sewage plant tanks then treated to reduce pathogens for use as a soil amendment or fertilizer.

The biosolids industry promotes the treated sludge as an environmentally friendly way to recycle waste that would otherwise end up in a landfill while saving farmers money on fertilizer. Critics believe the less tangible costs of the sludge far outweigh any benefits.

Luther, Oklahoma, property owners Walt and Saundra Traywick, say they were first introduced to biosolids by a sickening stench outside their home in 2018. They say they have been dealing with the impact of the treated sewage and the PFAS chemicals they carry ever since then.

“It’s that rotting carcass smell, but more metallic,” Walt told The Epoch Times.

Saundra Traywick said a neighbor was spreading biosolids from wastewater treatment plants in Oklahoma City and Tulsa on his land. She and some of her neighbors were able to get the practice banned in their town of Luther. And the company spreading the materials agreed to include buffer zones around their work area.

The Traywick family, (L–R) Hannah, Walt, Elaine, and Saundra, pose on their donkey dairy farm in Luther, Okla., on April 9, 2025. The Traywicks, whose daughter Hannah has an autoimmune disorder, are pushing to ban biosolids in the state over health concerns posed by chemicals in the material. Michael Clements/The Epoch Times

But, when she contacted the cities to complain, she was told “you shouldn’t have moved here if you didn’t like it, because we’ve been doing this for 40 years.”

Using biosolids as fertilizer has been controversial since the early part of this decade when per- and polyfluoroalkyl substances (PFAS), also called forever chemicals, were found in the sludge. The state of Maine has banned the practice over public health and safety concerns.

PFAS are called “forever chemicals” because they don’t degrade easily and can remain in soil, air, water, plants and animals even years after exposure.

The controversy was further heightened when the new head of the Environmental Protection Agency (EPA) announced he was tapping the brakes on a regulatory process begun under former President Joe Biden.

On May 14, EPA Administrator Lee Zeldin said the agency is maintaining its current guidelines for levels of PFAS in drinking water.

The EPA set drinking water limits of 4 parts per trillion for Perfluorooctanoic acid (PFOA) and Perfluorooctanesulfonate (PFOS) in March 2023. The agency also proposed a non-enforceable Maximum Contaminant Level Goals of zero for the chemicals because “there is no dose below which either chemical is considered safe.”

The EPA is also extending the deadline for water utilities to comply with the guidelines from 2029 to 2031.

“[Extending the deadline] will support water systems across the country, including small systems in rural communities, as they work to address these contaminants. EPA will also continue to use its regulatory and enforcement tools to hold polluters accountable,” Zeldin stated in the press release.

It is up to each state to regulate the use of biosolids using the EPA regulations as a guide. Only the state of Maine bans the practice.

Julie Lay, of Guntersville, Alabama, said she got her own rude awakening in June 1019.

Environmental Protection Agency Administrator Lee Zeldin testifies before the House Subcommittee on Environment on Capitol Hill in Washington on May 20, 2025. In a May 14 announcement, Zeldin said the agency will keep its current guidelines for PFAS levels in drinking water. Madalina Vasiliu/The Epoch Times

That is when she and her family also noticed a bad smell coming from a neighbor’s property. The wife and mother had worked in agribusiness for years. She had never encountered an odor like the one surrounding her home.

“It was an awful smell,” her husband Keith told The Epoch Times.

As she researched the source of the odor, Lay found that state agencies and agricultural groups she thought would oppose spreading sewage on farms were supportive of the practice as a cost-effective alternative to commercial fertilizer.

She said the people she spoke with repeated the claim that the biosolids were “nutrient-rich” and beneficial to the soil. They shrugged off any possible danger because no one could say for certain there is a problem, Lay said.

She is concerned that by the time a solid link between biosolids and disease is found, the damage to the land and the people who eat the food grown on it will already be done.

“So they used the land as a guinea pig and they used all of us as guinea pigs,” she told The Epoch Times.

The EPA reports that PFAS are found in all 50 states.

The chemicals make their way from manufacturing plants, industrial sites, and military installations, to wastewater treatment plants where they mix with residential sewage and wastewater.

The chemical bond is so strong that they survive the wastewater treatment process and remain in the sludge that is eventually sold as fertilizer.

3M, one of the largest makers of PFAS, agreed to begin phasing the chemicals out in 2000. However, since the chemicals have been around since the 1940s, a majority of Americans have likely already been exposed, the EPA reported.

A 2016 study published by the Department of Health and Human Services found evidence that chemicals in the PFAS family could disrupt the human immune system. Research also shows possible links to cancer.

https://www.zerohedge.com/food/homeowners-worried-about-chemicals-being-spread-sewage-fertilizer

'US to drop guidance to limit alcohol to one or two drinks per day, sources say'

 U.S. Dietary Guidelines are expected to eliminate the long-standing recommendation that adults limit alcohol consumption to one or two drinks per day, according to three sources familiar with the matter, in what could be a major win for an industry threatened by heightened scrutiny of alcohol's health effects.

The updated Dietary Guidelines for Americans, which could be released as early as this month, are expected to include a brief statement encouraging Americans to drink in moderation or limit alcohol intake due to associated health risks, the sources said.

The guidelines are still under development and subject to change, two of the sources and a fourth individual familiar with the process said.

Currently, the recommendations advise limiting drinking to one serving or less per day for women and two or less for men, widely seen as a moderate level.

Similar guidelines exist in countries such as the United Kingdom, which advises limiting drinking to 14 units per week, while Canada, however, has adopted a more cautious stance, warning that health risks begin to increase after just two drinks per week.

Even moderate drinking is linked to some health risks, such as higher risk of breast cancer, though some studies have also found an association with possible health benefits, such as a lower risk of stroke.

The fourth source said that the scientific basis for recommending specific daily limits is limited, and the goal is to ensure the guidelines reflect only the most robust evidence.

The new guidelines, developed by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture, are closely watched internationally and influence policies ranging from school lunch programs to medical advice. Neither department responded to requests for comment.

Health Secretary Robert F. Kennedy Jr., a known teetotaler, has remained largely silent on alcohol but has emphasised a focus on whole foods in the upcoming guidelines.

Some alcohol executives had feared a move towards tighter recommendations on alcohol intake as authorities like the World Health Organization upped their warnings about alcohol's health risks.

Former U.S. Surgeon General Vivek Murthy said alcohol consumption increases the risk of at least seven types of cancer and called for warning labels on alcoholic drinks.

Major industry players, including Diageo and Anheuser-Busch InBev, have lobbied lawmakers throughout the review process. Senate records show each company spent millions on lobbying efforts related to the guidelines and a range of other issues such as tax and trade in 2024 and 2025. Both companies declined to comment.

The new guidelines are set to move away from suggesting consumers limit alcohol consumption to a specific number of daily servings, according to the three sources, who asked not to be named in order to speak freely.

One person said the new alcohol-related recommendation will probably be limited to a sentence or two. Another said the existing numbers tied to moderate drinking could still appear in a longer appendix.

While industry representatives have lobbied lawmakers on the guidelines or how they should be decided, some officials and researchers advocated for tighter restrictions.

Reports intended to inform the guidelines have meanwhile drawn different conclusions about alcohol's health effects and the science around this.

'UNHELPFUL'

The guidelines, which are reviewed every five years, have advised drinking in moderation and defined that as no more than one drink per day for women and no more than two for men since 1990.

Eva Greenthal, a senior policy scientist at the Center for Science in the Public Interest, a non-profit focused on nutrition, health and food safety, said the more general language expected in the guidelines was "so vague as to be unhelpful".

Under such a change, the message that even moderate drinking can increase risks, especially for breast cancer, would get lost, she continued.

Two studies were produced to inform the development of the guidelines. The first found that moderate drinking was associated with increased risk of some cancers, but a decreased risk of dying from any cause and some cardiovascular problems like stroke.

The evidence for some other health impacts was insufficient to draw conclusions, it found.

The other report conversely found the risk of dying from alcohol use, including increased risk for seven cancers, begins at any or low levels of alcohol use and increases with higher consumption.

https://www.aol.com/news/exclusive-us-drop-guidance-limit-100739634.html

'Addiction to Screen Time Tied to Suicidality in U.S. Kids'

 

• Addictive screen use trajectories were associated with suicidal behaviors and ideation as well as worse mental health among U.S. kids in a large study.
• Increasing addictive use trajectories were associated with higher risks of suicide-related outcomes than low addictive use trajectories, and high addictive use trajectories for all screen types -- social media, mobile phones, and video games -- were associated with suicide-related outcomes.
• Compared with low addictive use trajectories, the high video game addictive use trajectory showed the largest relative difference in internalizing symptoms like anxiety and depression, and the increasing social media addictive use trajectory showed the largest relative difference in externalizing symptoms like aggression and rule-breaking.

Addictions to social media, mobile phones, and video games were associated with suicidal behaviors and ideation as well as worse mental health among U.S. kids, a cohort study suggested.

Addictive use as indicated by kids' self-reported compulsive use, difficulty disengaging, and distress when not using these technologies was common, with nearly one-third of participants scoring increasingly higher for addiction to social media or mobile phones beginning at age 11 years, Yunyu Xiao, PhD, of Weill Cornell Medicine/NewYork-Presbyterian in New York City, and colleagues reported in JAMAopens in a new tab or window.

Increasingly addictive use trajectories for social media and mobile phones were associated with higher risks of suicide-related outcomes, as were high addictive use trajectories for all three screen types in the cohort of 4,285 kids age 10 years who were followed for 4 years.

Compared with low addictive use trajectories, the high video game addictive use trajectory showed the largest relative difference in internalizing symptoms like anxiety and depression, while the increasing social media addictive use trajectory showed the largest relative difference in externalizing symptoms like aggression and rule-breaking.

"While most existing research has focused on total screen timeopens in a new tab or window, emerging evidence suggests that addictive screen use may be a more salient risk factoropens in a new tab or window for suicidality and mental health in youths," Xiao and colleagues wrote. "Addictive use may vary by platform and follow distinct developmental trajectories. However, addictive use trajectories among youths have not been well characterized, and how they may relate to suicide-related and mental health outcomes remains largely unknown."

Indeed, the study's findings "suggest that addictive screen use is more strongly linked to negative mental health outcomes than screen time alone," wrote Jason Nagata, MD, MSc, of the University of California San Francisco, and colleagues in an accompanying editorialopens in a new tab or window. "These results emphasize the importance of addressing not just screen time but also addictive behaviors in adolescents."

High and/or increasing addictive screen use trajectories were common among study participants, who had a mean age of 10 years at baseline. Nearly one-third of kids had an increasing addictive use trajectory for social media or mobile phones beginning at 11 years of age. And about 41% of participants had a high addictive use trajectory for video games.

Notably, there were 30% to 40% of kids who "started with low addiction use and ended up with higher addiction use," Xiao told MedPage Today in emailed remarks. "[I]f you do not follow the kids over time, you would miss this substantial group that shifts from low risk to higher risk."

Overall, 5.1% of participants reported suicidal behaviors and 17.9% reported suicidal ideation at follow-up of 4 years. Child and parent reports over the prior year were assessed via the Kiddie Schedule for Affective Disorders and Schizophreniaopens in a new tab or window, which covers nine outcomes ranging from passive ideation to preparatory actions for imminent suicidal behavior and suicide attempt. For other mental health concerns, there were parent-reported internalizing and externalizing symptoms using the Child Behavior Checklistopens in a new tab or window.

For social media, patterns of use that peaked with high addictive use scores or that grew increasingly addictive were associated with significantly higher risk of suicidal behaviors (RR 2.39 and 2.14, respectively, P<0.001 for both) and of suicidal ideation (RR 1.51 and 1.46, P<0.001 for both) compared with the low addictive risk trajectory.

For mobile phones, the high addictive use trajectory was associated with higher risk of suicidal behaviors and suicidal ideation (RR 2.17 and 1.50, both P<0.001) than the low addictive use trajectory. And the increasing addictive use trajectory was modestly associated with a greater relative risk of suicidal ideation (RR 1.22, P<0.001).

As for video games, the high addictive use trajectory was associated with higher risk of suicidal behaviors (RR 1.54, P=0.004) and suicidal ideation (RR 1.53, P<0.001) than the low addictive risk trajectory.

Total screen time at baseline was not associated with suicidal behaviors or ideation or internalizing or externalizing symptoms, they found.

The study used data from the Adolescent Brain Cognitive Development (ABCD) study, with population-based samples from 21 sites across the U.S.

Limitations included the observational nature of the study and reliance on self-reported data, Xiao and colleagues noted. Also, the pandemic could have influenced screen time, the ABCD study did not assess multitasking across screen platforms, and 4-year follow-up data were not available for all participants.

Additionally, psychosocial and behavioral factors like bullying, adverse childhood experiences, and social determinants of health were not assessed, they noted.

Ultimately, "[n]ow that we know the addictive use pattern is so important," Xiao said, "we need to develop intervention strategies and test them in controlled clinical trials."

Disclosures

The study was supported by funding from the National Institute of Mental Health, the American Foundation for Suicide Prevention, and Google.

Xiao disclosed no relevant relationships with industry. A co-author of the study reported receipt of royalties for commercial use of the Columbia-Suicide Severity Rating Scale from the Research Foundation for Mental Hygiene and the Columbia Pathways App from Columbia University.

The editorialists did not report any relevant conflicts of interest.

Primary Source

JAMA

Source Reference: opens in a new tab or windowXiao Y, et al "Addictive screen use trajectories and suicidal behaviors, suicidal ideation, and mental health in US youths" JAMA 2025; DOI: 10.1001/jama.2025.7829.

Secondary Source

JAMA

Source Reference: opens in a new tab or windowNagata JM, et al "Beyond screen time -- Addictive screen use patterns and adolescent mental health" JAMA 2025; DOI: 10.1001/jama.2025.8135.

https://www.medpagetoday.com/pediatrics/generalpediatrics/116127

An instantaneous voice-synthesis neuroprosthesis

 

Maitreyee Wairagkar,
Nicholas S. Card,
Tyler Singer-Clark,
Xianda Hou,
Carrina Iacobacci,
Lee M. Miller,
Leigh R. Hochberg,
David M. Brandman &
Sergey D. Stavisky

Abstract

Brain–computer interfaces (BCIs) have the potential to restore communication for people who have lost the ability to speak owing to a neurological disease or injury. BCIs have been used to translate the neural correlates of attempted speech into text1,2,3. However, text communication fails to capture the nuances of human speech, such as prosody and immediately hearing one’s own voice. Here we demonstrate a brain-to-voice neuroprosthesis that instantaneously synthesizes voice with closed-loop audio feedback by decoding neural activity from 256 microelectrodes implanted into the ventral precentral gyrus of a man with amyotrophic lateral sclerosis and severe dysarthria. We overcame the challenge of lacking ground-truth speech for training the neural decoder and were able to accurately synthesize his voice. Along with phonemic content, we were also able to decode paralinguistic features from intracortical activity, enabling the participant to modulate his BCI-synthesized voice in real time to change intonation and sing short melodies. These results demonstrate the feasibility of enabling people with paralysis to speak intelligibly and expressively through a BCI.

https://www.nature.com/articles/s41586-025-09127-3

Dupilumab for Atopic Dermatitis Linked to Increased Risk of Psoriasis

 

• The use of dupilumab for the treatment of atopic dermatitis was associated with an increased risk of psoriasis compared with other systemic agents.
• The association between dupilumab and psoriasis was further supported by validation in patients with asthma without atopic dermatitis.
• This suggests that dupilumab may act as a trigger in promoting psoriasis.

The use of dupilumab (Dupixent) for the treatment of atopic dermatitis was associated with an increased risk of psoriasis compared with other systemic agents, according to a retrospective cohort study.

Among over 19,000 matched patients, the 3-year cumulative incidence of psoriasis was 2.86% with dupilumab versus 1.79% with other systemic agents (P<0.001), with a number needed to harm of 94, reported Chun-Ying Wu, MD, MPH, PhD, of National Yang Ming Chiao Tung University in Taipei, Taiwan, and colleagues in JAMA Dermatologyopens in a new tab or window

The dupilumab cohort had an increased risk for psoriasis (HR 1.58, 95% CI 1.25-1.99), although the risk for psoriatic arthritis (PsA) was not significant (HR 1.97, 95% CI 0.75-5.18).

Key findings of subgroup analyses included an observed increased psoriasis risk in patients without atopic comorbidities (HR 1.42, 95% CI 1.06-1.89) and those with pretreatment immunoglobulin E (IgE) levels less than 0.048 mg/dL (HR 1.59, 95% CI 1.26-2.01).

The association between dupilumab and psoriasis was further supported by validation in patients with asthma without atopic dermatitis (HR 2.13, 95% CI 1.38-3.31), the authors noted.

"Since psoriasis prevalence in general AD [atopic dermatitis] populations ranges from 0.3% to 12.6%, the dupilumab cohort's psoriasis rate, although higher than the control cohort, remained within this range," Wu and team wrote. "This suggests that dupilumab may act more as a trigger rather than a decisive factor in promoting psoriatic eruption in patients with AD."

"Recent proposals suggest that AD and psoriasis may exist on a spectrumopens in a new tab or window, with varying Th2-Th17 polarization associated with overlapping disease features," they explained. "Because IL [interleukin]-4 and IL-13 negatively regulate Th17 function, their blockade by dupilumab may skew immune responses toward Th17-driven inflammation, potentially triggering psoriasis."

However, "such an immune shift following dupilumab may not be straightforward in all patients," they added.

Danilo C. Del Campo, MD, of the Chicago Skin Clinic, told MedPage Today that "this immune shift from Th2 to Th17 dominance is certainly something we have seen in private practice, and it's encouraging to see it supported by a large, well-designed cohort study."

"That said, I do not see this as practice-changing at this point," he added. "Dupilumab remains an effective and well-tolerated option for many patients with moderate-to-severe atopic dermatitis. Awareness of this potential risk can help guide monitoring and patient counseling, particularly in those with a personal or family history of psoriasis."

Shoshana Marmon, MD, PhD, of New York Medical College in Valhalla, told MedPage Today that "the observed association between dupilumab and psoriasis in patients with asthma (but not atopic dermatitis) supports a likely drug-related trigger related to this shift in immune balance. While the absolute risk remains low, clinicians should be aware of this potential adverse effect, particularly in patients 60 years or older, without atopic comorbidities, or with lower baseline IgE levels."

"Though relatively rare, this paradoxical reaction highlights the need for increased clinical awareness when evaluating new-onset psoriasiform lesions in patients receiving dupilumab," she noted. "Clinicians should remain aware of this risk but balance it against dupilumab's strong efficacy in treating moderate-to-severe atopic dermatitis."

Observations of arthritis and enthesitis resembling PsA following dupilumab initiation also support a possible connection to a psoriatic disease phenotype, Wu and colleagues said. However, observational dataopens in a new tab or window link more than a quarter of musculoskeletal events to non-inflammatory causes; thus, "identifying the role of PsA in inflammatory cases remains challenging. As psoriatic skin lesions often precede PsA, patients may discontinue dupilumab after developing psoriasis, preventing further progression. If PsA occurs first, the absence of skin symptoms may lead to a missed diagnosis."

This population-based retrospective cohort study included adults with atopic dermatitis from the TriNetX Global Collaborative Network. Propensity score matching at a 1:1 ratio was based on age, sex, race, comorbidities, laboratory measurements, and prior medications.

Wu and colleagues analyzed 19,720 patients, 9,860 who were prescribed dupilumab and 9,860 who were prescribed other systemic agents (corticosteroids, methotrexate, cyclosporine, azathioprine, or mycophenolate mofetil). Mean age in both groups was 44.8, 55.2% were women, 50.2% were white, 18.2% were Black, and 10.2% were Asian.

Due to the observational nature of the study, the authors could only report an increased risk of psoriasis in patients receiving dupilumab without establishing causality, which was a limitation.

Disclosures

This work was supported in part by the National Science Technology Council of Taiwan and Taichung Veterans General Hospital.

The study authors had no disclosures.

Del Campo and Marmon had no disclosures.

Primary Source

JAMA Dermatology

Source Reference: opens in a new tab or windowLin T-L, et al "Psoriasis risk in patients with atopic dermatitis treated with dupilumab" JAMA Dermatol 2025; DOI: 10.1001/jamadermatol.2025.1578.

https://www.medpagetoday.com/dermatology/psoriasis/116153