Systemic treatment for psoriasis and malignancies: A real risk?

Napolitano, Maddalena; Megna, Matteo; Patrì, Angela; Balato, Anna; Patruno, Cataldo; Monfrecola, Giuseppe; Balato, Nicola

doi:10.1111/dth.12508

Cited by 7 publications

(5 citation statements)

References 5 publications

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“…Compared with patients receiving conventional therapy, no increased risk of cancer was seen (RR, 0.97; 95% CI, 0.85-1.10) (Table 3, Figure 2). When excluding keratinocyte cancer, 6 studies (n = 25 430) could be included …”

Section: Resultsmentioning

confidence: 99%

Prevalence, Incidence, and Risk of Cancer in Patients With Psoriasis and Psoriatic Arthritis

et al. 2020

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IMPORTANCEThe association between psoriasis and risk of cancer remains debatable.OBJECTIVE To evaluate the association and risk of cancer in patients with psoriasis or psoriatic arthritis, including risk of specific cancer subtypes.DATA SOURCES Two databases (PubMed and Embase) were screened from inception to January 1, 2019, using the search string psoriasis or psoriatic and neoplasms or malignancy or cancer. The search was filtered to only include human participants and publications in English.STUDY SELECTION Observational cohort studies with a population of patients with psoriasis or psoriatic arthritis were included. Studies had to be original and report the incidence or prevalence of cancer within this population. Studies evaluating pediatric populations and cancer types not included in the protocol were excluded. DATA EXTRACTION AND SYNTHESISThis study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search string, objectives, and study protocol methods were defined before the study was initiated. A total of 365 studies were included for full-text assessment. Owing to the heterogeneity of the included studies, a random-effects model was used.MAIN OUTCOMES AND MEASURES Main outcome was cancer (overall and specific subtypes) and measures were prevalence, incidence, and risk estimate for cancer in patients with psoriasis or psoriatic arthritis. RESULTSOf the 365 studies assessed, 112 were included in the analysis (N = 2 053 932 patients). The overall prevalence of cancer in patients with psoriasis was 4.78% (95% CI, 4.02%-5.59%), with an incidence rate of 11.75 per 1000 person-years (95% CI, 8.66-15.31) and a risk ratio (RR) of 1.21 (95% CI, 1.11-1.33). There was an increased risk of several cancers, including keratinocyte cancer (RR, 2.28; 95% CI, 1.73-3.01), lymphomas (RR, 1.56; 95% CI, 1.37-1.78), lung cancer (RR, 1.26; 95% CI, 1.13-1.40), and bladder cancer (RR, 1.12; 95% CI, 1. 04-1.19). No increased risk of cancer for patients with psoriasis treated with biologic agents was found (RR, 0.97; 95% CI, 0.85-1.10). Psoriatic arthritis was not associated with increased risk of cancer overall (RR, 1.02; 95% CI, 0.97-1.08).CONCLUSIONS AND RELEVANCE Patients with psoriasis appear to have a slightly increased risk of cancer, particularly keratinocyte cancer and lymphomas. Data on treatment with biologic agents did not show an increased risk of cancer. Data on cancer in patients with psoriatic arthritis remain scarce, and further research is warranted in this area.

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Section: Resultsmentioning

confidence: 99%

Prevalence, Incidence, and Risk of Cancer in Patients With Psoriasis and Psoriatic Arthritis

et al. 2020

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“…As a result of a high baseline risk of infection, caution is required when administering these medications, especially in geriatric patients [ 10 ]. Besides, the long-term repercussions, mainly the risk of developing malignant tumors, is still controversial; some studies have suggested that these treatments do not seem to increase this risk [ 18 ]. Moreover, they are not available in many countries.…”

Section: Discussionmentioning

confidence: 99%

A Case of Nail Psoriasis Successfully Treated with Intralesional Methotrexate

Mokni

Ameur

Ghariani

et al. 2018

Dermatol Ther (Heidelb)

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Psoriasis is a chronic inflammatory disease affecting the skin, nails, and joints. About 61% of psoriatic patients have nail involvement that can cause a significant social problem. Treating nail psoriasis is challenging but can improve the health outcomes and quality of life of patients. Treatment options available for nail psoriasis including topical therapy, intralesional injections, and systemic and biologic agents have various side effects and some benefits. Management is currently inconclusive. Intralesional injection of methotrexate in nail psoriasis was previously documented in few cases. We present a case of nail psoriasis successfully treated with low-dose intralesional methotrexate with no significant side effects in a 48-year-old psoriatic patient. Given the various side effects of conventional topical and systemic therapies limiting their use, we conclude that intralesional methotrexate injection seems to be a safe and effective treatment option for nail psoriasis. However, large controlled studies are needed.

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“…33 A 12-year retrospective study comparing malignancy risk in patients with psoriasis administered conventional and biological treatments showed that biological drugs did not increase the malignancy risk. 34 In addition, a recent prospective longitudinal cohort study also concluded that biological medications were not associated with increased malignancy risk in patients with psoriasis. 6 Our study found similar results regarding the safety of ustekinumab.…”

Section: Discussionmentioning

confidence: 99%

“…The results of a post‐marketing cohort study in 2015 also indicated that ustekinumab was not associated with increased malignancy risk 33 . A 12‐year retrospective study comparing malignancy risk in patients with psoriasis administered conventional and biological treatments showed that biological drugs did not increase the malignancy risk 34 . In addition, a recent prospective longitudinal cohort study also concluded that biological medications were not associated with increased malignancy risk in patients with psoriasis 6 .…”

Section: Discussionmentioning

confidence: 99%

Risk of malignancy in patients with psoriasis receiving systemic medications: A nested case‐control study

Chou

Pan

et al. 2022

Dermatologic Therapy

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Large-scale, real-world studies on the side effects of systemic therapies (including biologics) in patients with psoriasis are limited. We aimed to calculate the risk of malignancy in patients with psoriasis who were treated with systemic medications.Nested case-control analyses were performed among psoriasis patients without a history of malignancy. We recruited 4188 patients with newly diagnosed psoriasis and successive malignancies, and 8376 matched controls from the National Health Insurance Research Database in Taiwan. The therapy duration was within 5 years before malignancy onset and further stratified into two groups according to the duration of medication usage. Multivariate conditional logistic regression adjusted for potential confounders was used to estimate malignancy risk associated with systemic treatments. Among psoriasis patients, long-term (> 12 months) treatment with cyclosporine increased the risk of malignancy compared with no exposure (odds ratio, 1.57; p = 0.01). Short-term (≤ 12 months) or long-term (> 12 months) use of other systemic treatments, including methotrexate, azathioprine, systemic retinoids, mycophenolate mofetil, sulfasalazine, etanercept, adalimumab, and ustekinumab, was not associated with an increased risk of malignancy in patients with psoriasis. Long-term treatment with cyclosporine increased the risk of malignancy in patients with psoriasis by 1.57-fold.

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Systemic treatment for psoriasis and malignancies: A real risk?

Cited by 7 publications

References 5 publications

Prevalence, Incidence, and Risk of Cancer in Patients With Psoriasis and Psoriatic Arthritis

Prevalence, Incidence, and Risk of Cancer in Patients With Psoriasis and Psoriatic Arthritis

A Case of Nail Psoriasis Successfully Treated with Intralesional Methotrexate

Risk of malignancy in patients with psoriasis receiving systemic medications: A nested case‐control study

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