Chang-Ching Wei

Background: Atopic dermatitis (AD) is associated with neuropsychiatric comorbidity, yet no study has directly compared neuropsychiatric outcomes across all three major systemic treatment classes. This study examined neuropsychiatric outcomes among patients with AD receiving Janus kinase (JAK) inhibitors, dupilumab, or conventional immunosuppressants. Methods: This retrospective cohort study utilized the TriNetX global health research network. Three propensity score-matched cohorts were constructed based on demographics, comorbidities, and concomitant medications. The primary outcome was incident neuropsychiatric disorder within 24 months. Results: After matching, cohorts included 608 (JAK inhibitors vs. dupilumab), 502 (JAK inhibitors vs. conventional), and 2322 patients (dupilumab vs. conventional). In the largest cohort, conventional immunosuppressants were associated with a significantly higher incidence of neuropsychiatric disorders compared with dupilumab (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.00–1.59; p = 0.042). A similar directional trend was observed for conventional immunosuppressants compared with JAK inhibitors (HR 1.97, 95% CI 1.13–3.42; p = 0.015). The comparison between JAK inhibitors and dupilumab did not reach statistical significance (HR 0.62, 95% CI 0.37–1.03; p = 0.063). Findings regarding rare outcomes, such as autism spectrum disorders, were based on very low event counts and should be interpreted with extreme caution. Conclusions: In this large propensity-matched cohort, dupilumab was associated with significantly lower neuropsychiatric disorder incidence compared with conventional systemic immunosuppressants, with a similar directional trend observed for JAK inhibitors. These hypothesis-generating findings suggest potential neuropsychiatric outcome differences among systemic therapies for AD, warranting further investigation to establish whether the associations reflect treatment effects or residual confounding.

Background: Pediatric uveitis, though accounting for less than 10% of all uveitis cases, presents significant diagnostic and therapeutic challenges due to its asymptomatic onset and potential for severe, vision-threatening complications. Despite known associations with autoimmune diseases, data on risk factors in Asian pediatric populations remain limited. This study aimed to quantify the risk of uveitis in Taiwanese children with autoimmune diseases, identify key comorbidities, and evaluate the effects of immunosuppressive therapies. Methods: Using Taiwan’s National Health Insurance Research Database (2009–2019), we conducted a nationwide retrospective cohort study of 3,643 pediatric patients with autoimmune diseases matched 1:1 to controls. Patients were followed for up to 12 years, with uveitis risk assessed through Cox proportional hazards models and cumulative incidence analyzed using Kaplan-Meier curves. Results: During a mean follow-up of 5.5 years, autoimmune diseases were associated with increased uveitis risk (adjusted HR [aHR] = 2.65 [95% CI, 1.67-4.19]), with juvenile idiopathic arthritis showing the highest risk (aHR = 25.70 [95% CI, 7.41-89.22]). Risk was significant only in adolescents aged 10-14 years (aHR = 2.58 [95% CI, 1.29-5.14]) and 15-18 years (aHR = 2.60 [95% CI, 1.27-5.31]) and was notably higher in patients without diabetes (aHR = 6.88 [95% CI, 2.54-18.61]) compared with those with diabetes (aHR = 1.67 [95% CI, 0.98-2.82]). In medication analysis, sulfasalazine use (aHR = 2.00 [95% CI, 1.04-3.84]) and high-daily dose prednisolone (≥30 mg/day; aHR = 2.25 [95% CI, 1.12-4.53]) were associated with increased risk, while moderate cumulative prednisolone doses were associated with a lower risk compared with low-dose exposure (aHR = 0.32 [95% CI, 0.13-0.79]). Conclusion: This cohort study identified distinct patterns of uveitis risk across specific autoimmune diseases and age groups. These findings suggest the need for risk-stratified ophthalmologic screening based on autoimmune diagnosis and age in pediatric patients requiring immunosuppressive therapy.

Background: Atopic dermatitis (AD) predominantly manifests before age five, with significant phenotype variations across age groups. Despite increasing systemic treatments for pediatric AD, head‐to‐head comparisons in network meta‐analyses focused on children are scarce. Methods: Through systematic searches of PubMed, Embase, Web of Science, and Cochrane Library up to March 2024, we identified randomized controlled trials (RCTs) evaluating systemic treatments for moderate‐to‐severe AD in children aged 2–18 years. From 900 screened articles, 8 RCTs ( n = 2636) met inclusion criteria, comparing dupilumab, baricitinib, upadacitinib, and abrocitinib versus placebo with standard care. Primary outcome was Eczema Area and Severity Index (EASI) scores at 12–16 weeks. Results: Upadacitinib demonstrated highest efficacy at both 30 mg (risk difference [RD] 0.62 [0.53, 0.71]) and 15 mg (RD 0.52 [0.42, 0.62]). Dupilumab (weight‐based dosing with corticosteroids; RD 0.43 [0.29, 0.57]), abrocitinib (200 mg; RD 0.40 [0.29, 0.50]; 100 mg; RD 0.30 [0.20, 0.41]), and baricitinib (4 mg; RD 0.21 [0.06, 0.35]) also showed significant efficacy over placebo. Conclusion: This analysis establishes a hierarchy of effectiveness among systemic therapies for pediatric AD, with upadacitinib showing highest efficacy. However, the predominance of adolescent data emphasizes the need for age‐stratified studies in younger children and long‐term safety assessments.

Studies have associated the human respiratory syncytial virus which causes seasonal childhood acute bronchitis and bronchiolitis (CABs) with climate change and air pollution. We investigated this association using the insurance claims data of 3,965,560 children aged ≤ 12 years from Taiwan from 2006–2016. The monthly average incident CABs increased with increasing PM_2.5 levels and exhibited an inverse association with temperature. The incidence was 1.6-fold greater in January than in July (13.7/100 versus 8.81/100), declined during winter breaks (February) and summer breaks (June–August). The highest incidence was 698 cases/day at 37.0 μg/m³, with an adjusted relative risk (aRR) of 1.01 (95% confidence interval [CI] = 0.97–1.04) compared to 568 cases/day at 2.5 < 15.0 μg/m³ (reference). The incidence at ≥30 °C decreased to 536 cases/day (aRR = 0.95, 95% CI = 0.85–1.06) with PM_2.5 > 37.0 μg/m³ and decreased further to 392 cases/day (aRR = 0.61, 95% CI = 0.58–0.65) when PM_2.5 was 3. In conclusion, CABs infections in children were associated with lowered ambient temperatures and elevated PM_2.5 concentrations, and the high PM_2.5 levels coincided with low temperature levels. The role of temperature should be considered in the studies of association between PM_2.5 and CABs.

Background: To date, there is insufficient knowledge about the association of air pollution and childhood nephrotic syndrome in the real world. This study aimed to evaluate the effects of the three common gaseous air pollutants, including sulfur dioxide, total hydrocarbon, and methane, on the risk of idiopathic nephrotic syndrome (INS) in children.Methods: We collected data from the Taiwan National Health Insurance Research Database and Taiwan Air Quality-Monitoring Database. Children younger than 18 years old, identified from January 1, 2000, were followed up until the first diagnosis of INS was established or until December 31, 2012. We measured the incidence rates and hazard ratios for INS stratified based on the quartiles (Q1–Q4) of air pollutant concentration. Multivariate Cox proportional hazards models were also applied by adjusting age, sex, monthly income, and urbanization.Results: Compared with participants exposed to Q1 concentrations, the adjusted hazard ratios (aHRs) for INS increased progressively along the four quartiles of sulfur dioxide, total hydrocarbon, and methane, from 1 (Q1) to 1.78 (Q4), 1 (Q1) to 3.49 (Q4), 1 (Q1) to 7.83 (Q4), respectively.Conclusions: Our study revealed that children with exposure to higher concentrations of sulfur dioxide, total hydrocarbon, and methane was associated with an increased risk of INS.