Melanoma Risk in Patients Treated With Biologic Therapy for Common Inflammatory Diseases

Abstract

IMPORTANCE Biologic therapies are widely prescribed immunomodulatory agents. There are concerns that compared with treatment with conventional systemic therapy, long-term biologic treatment for common immune-mediated inflammatory diseases, namely inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and psoriasis, may be associated with increased risk of melanoma.OBJECTIVE To examine whether biologic treatment of IBD, RA, or psoriasis is associated with an increased risk of melanoma compared with conventional systemic therapy.DATA SOURCES Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for articles published from January 1, 1995, to February 7, 2019, for eligible studies.STUDY SELECTION Randomized clinical trials, cohort studies, and nested case-control studies quantifying the risk of melanoma in biologic-treated patients with IBD, RA, and psoriasis compared with patients treated with conventional systemic therapy were included.DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted key study characteristics and outcomes. Study-specific risk estimates were pooled, and random-and fixed-effects model meta-analyses were conducted. Heterogeneity was assessed using the I 2 statistic. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. MAIN OUTCOMES AND MEASURESThe pooled relative risk (pRR) of melanoma in biologic-treated patients with IBD, RA, and psoriasis compared with biologic-naive patients treated with conventional systemic therapy. RESULTSSeven cohort studies comprising 34 029 biologic-treated patients and 135 370 biologic-naive patients treated with conventional systemic therapy were eligible for inclusion. Biologic treatment was positively associated with melanoma in patients with IBD (pRR, 1.20; 95% CI, 0.60-2.40), RA (pRR, 1.20; 95% CI, 0.83-1.74), or psoriasis (hazard ratio, 1.57; 95% CI, 0.61-4.09) compared with those who received conventional systemic therapy, but the differences were not statistically significant. Adjustment for other risk factors was absent from most studies. CONCLUSIONS AND RELEVANCEThe findings suggest that clinically important increases in melanoma risk in patients treated with biologic therapy for common inflammatory diseases cannot be ruled out based on current evidence. However, further studies with large patient numbers that adjust for key risk factors are needed to resolve the issue of long-term safety of biologic therapy.

Incidence of Skin Cancer in Patients With Chronic Inflammatory Cutaneous Diseases on Targeted Therapies: A Systematic Review and Meta-Analysis of Observational Studies

“…A study by Esse and collaborators was focused on melanoma risk in patients treated with biologics for common inflammatory diseases, such as inflammatory bowel diseases, rheumatoid arthritis and psoriasis ( 68 ). In detail, they considered a total of 7 studies, consisting of patients treated with TNF-α inhibitors, one of which regarding patients with psoriasis and, moreover, included in our review ( 74 ). According with their findings, the risk of melanoma in biologic-treated patients with IBD and psoriasis compared with their biologic-naïve counterparts receiving conventional systemic therapy showed no statistically significant increases.…”

Adverse Events Associated With Anti-IL-23 Agents: Clinical Evidence and Possible Mechanisms

“…Type ϵ is the only non-immunological AE form, which may be associated with longterm medication. Previous studies (68,69) have shown that excessive release of pathological inflammatory mediators may lead to a high incidence of anxiety and depression; moreover, the application of BAs induces psychologically relevant AEs. The most common type ϵ AE was psychiatric disorder with an incidence of 0.75% (Table S3 and Figure S7.5.1).…”

<p>Use of Immunomodulating Drugs and Risk of Cutaneous Melanoma: A Nationwide Nested Case-Control Study</p>

“…24 Other drugs with immunosuppressant actions, commonly used to treat these diseases, are also suggested to increase the melanoma risk. [25][26][27] Furthermore, the propensity of certain immunosuppressants to exacerbate UVR-induced DNA damage is theorized to be responsible for a potential elevated risk of melanoma. 28,29 Corticosteroids, and glucocorticoids in particular, are used as part of a variety of anti-inflammatory and immunosuppressive therapies, for conditions such as rheumatoid arthritis, inflammatory bowel syndrome, psoriasis, and eczema.…”