Risk of Malignancies in Psoriasis Patients Treated with Cyclosporine: a 5 y Cohort Study

Abstract

This prospective long-term cohort study investigated the incidence of malignancies in severe psoriasis patients treated with cyclosporine. A total of 1252 patients were followed prospectively for up to 5 y. Malignancies were recorded prospectively. Incidence rates for malignancies were compared with the general population using standardized incidence ratios. The effect of duration of exposure to cyclosporine and to previously administered anti-psoriatic treatments on the incidence of malignancies was investigated using Poisson regression models. The mean age of patients was 43 y and on average, patients received cyclosporine for 1.9 y. Malignancies were diagnosed in 47 patients (3.8%), 49% of them had skin malignancies. The standardized incidence ratio in the study cohort was 2.1 as compared with the general population. The higher incidence of malignancies was attributed to a 6-fold higher incidence of skin malignancies, most of which were squamous cell carcinoma. The incidence of nonskin malignancy overall was not significantly higher in this study than in the general population. Duration of exposure to cyclosporine, exposure to psoralen and ultraviolet A, exposure to methotrexate, and exposure to immunosuppressants showed a significant effect on the incidence of nonmelanoma skin malignancies. In conclusion, treatment of psoriasis with cyclosporine is associated with an increased risk of nonmelanoma skin cancer. Patients treated for more than 2 y with cyclosporine were shown to have a higher risk. In addition, exposure to psoralen and ultraviolet A and to other immunosuppressants was shown to contribute to the overall risk.

Eruption of palmoplantar pustular psoriasis in patient treated with anti-androgen therapy for prostate cancer and aggravation of lesions after statin treatment

“…In the available literature there is some evidence to suggest a relationship between psoriasis and cancerogenesis [1,2]. In our report the anti-androgen treatment caused the manifestation of psoriasis.…”

“…Cutaneous manifestation is always a predominant clinical feature. However, several reports suggested that there might be a link between psoriasis and disorders of other organs, including malignancy [1,2]. The complex etiopathogenesis of psoriasis includes interaction of various genetic, environmental and immunological factors.…”

Efficacy and safety of leflunomide in the treatment of psoriatic arthritis and psoriasis: A multinational, double‐blind, randomized, placebo‐controlled clinical trial

“…Because of the high placebo response rate in patients with PsA (14), data from uncontrolled trials may be misleading. In addition, discontinuation rates due to lack of response and adverse events are typically high for conventional systemic therapies (38), and longterm safety is a concern (39,40). Two biologic agents, etanercept and infliximab, have recently been shown to be effective in the treatment of PsA, and these agents along with alefacept also reduce psoriasis symptoms (17)(18)(19).…”

National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening

“…80,81,85 Additionally, treatment of psoriasis patients with cyclosporine and methotrexate has been associated with the development of lymphoma. [99][100][101] There is also concern that the biologic therapies used to treat psoriasis, which selectively target specific components of the immune system, might increase the risk of lymphoma in these patients.…”