Treatments for psoriasis and the risk of malignancy

Patel, Rita V.; Clark, Lily; Lebwohl, Mark; Weinberg, Jeffrey M

doi:10.1016/j.jaad.2008.12.031

Cited by 204 publications

(163 citation statements)

References 113 publications

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“…[9][10][11][12][13][14][15][16] Among patients with psoriasis using systemic therapies, there is as much as a 50% greater risk for all malignancies when excluding NMSC and lymphoproliferative malignancies, a 4-fold increased relative risk of NMSC, and an 8-times greater risk of lymphoproliferative malignancies. [10][11][12][13][14][15][16] Among patients with autoimmune inflammatory conditions such as psoriasis, the incidence of serious infectious events (SIEs) is increased among those using antipsoriatic treatments. [17][18][19][20] Some studies suggest lower rates among patients < 65 years old compared with patients aged 65 and older.…”

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confidence: 99%

Incidence rates of malignancies and hospitalized infectious events in patients with psoriasis with or without treatment and a general population in the U.S.A.: 2005–09

et al. 2014

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SummaryBackground Rates of malignancies and hospitalized infectious events (HIEs) among psoriasis patients are higher than in the general population, but it is unclear if higher rates are associated with the underlying inflammatory state, treatments or both. Objectives To assess the incidence of malignancies and HIEs in a healthy US population, a psoriasis population, and four treated psoriasis populations. Methods Using a US claims database, we identified a general population, a psoriasis cohort, and four treatment cohorts [non-biologic systemics, etanercept, other TNF blockers (adalimumab, infliximab) and phototherapy] to assess the incidence of lymphomas, nonmelanoma skin cancer (NMSC), all malignancies (excluding NMSC), and HIEs, standardized for age and sex. Results Among 40 987 patients with psoriasis, 11% were prescribed non-biologics, 15% etanercept, 6% other TNF blockers and 11% phototherapy. For all cancers, the psoriasis population rate (114/10 000 person-years) was 20% greater than the rate found in the general population (95/10 000 person-years). For NMSC, the psoriasis population rate (129/10 000 person-years) was 65% greater than the general population rate (78/10 000 person-years). The incidence rate for each treatment modality was lower than the overall psoriasis cohort, except for phototherapy. There was little difference in the rates of lymphomas. NMSC rates were higher among patients treated with phototherapy. HIE rates ranged from 165/10 000 person-years for the phototherapy group to 262/10 000 person-years for the other anti-TNF group. Conclusions Patients with psoriasis appear to have higher rates of malignancy and HIE than the general population, with little difference in rates between the treatment methods, except for a higher rate of cancer among those receiving phototherapy.

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confidence: 99%

Incidence rates of malignancies and hospitalized infectious events in patients with psoriasis with or without treatment and a general population in the U.S.A.: 2005–09

et al. 2014

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“…Other treatments, methotrexate, cyclosporin and mycophenolate may be associated with increased risk of lymphoproliferative disorders. The situation is less clear concerning biologicals, but most studies suggest a slightly increased risk of non-melanoma skin cancer and lymphoma [70][71][72]. One study showed a higher incidence of lymphoma for adalimumab (SIR 4.1) and infliximab ((SIR) 3.6 than for etanercept (SIR 0.9) in patients with rheumatoid arthritis [73].…”

Section: Sheets For the Presentationmentioning

confidence: 99%

Biologicals in the Treatment of Plaque Psoriasis: Drug Selection by Means of the SOJA Method

Janknegt¹

2016

J Pharma Care Health Sys

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The treatment of plaque psoriasis is changing because of the introduction of new treatment options. The goal of this article is to allow a transparent and rational choice of medicines by means of the System of Objectified Judgement Analysis. The following selection criteria (relative weight) were applied: approved indications (40), drug interactions (60), clinical efficacy (400), safety (300), dosage frequency (100) and documentation (100). Acquisition cost was not taken into consideration to allow a preselection on quality aspects only. Adalimumab, etanercept, infliximab and ustekinumab were compared on these criteria. Infliximab and ustekinumab showed the highest scores and are the most suitable medicines for the treatment of severe plaque psoriasis. Of course, cost will play a key role in the final selection in individual hospitals. Weight Approved indications 40 Drug Interactions 60Clinical efficacy 400Safety 300Dosage frequency 100 Documentation 100Total 1000 Selection Criteria Approved IndicationsThe number of licensed indications is a good measure of the applicability and documentation of the drugs. Although this analysis is limited to the treatment of plaque psoriasis, the fact that a drug is approved for (almost) all indications listed below is, from a formulary point of view, advantageous to another drug, which is approved for only one or two applications.The percentage of the maximum score for approved indications was obtained as follows (Table 2): IndicationMaximum Score (%)Plaque psoriasis 50% Psoriatric arthritis 20%Rheumatoid arthritis 10% Spondylitis ankylopoetica 10%Inflammatory bowel disease 10% Drug interactionsInteractions play a role only in patients who use other drugs which may interact with biologicals. However, it is a relevant criterion from a formulary point of view.The score for each drug was dependent on the frequency and severity of observed drug interactions. Clinical efficacyClinical efficacy is always a very important selection criterion for any group of drugs. The score for each drug was derived from the results of double-blind comparative studies. SafetyThe extent and the severity of adverse effects is another important selection criterion for drugs. A distinction was made between "minor" side effects, such as gastrointestinal disturbances or skin reactions, occurring in clinical trials and severe or even life-threatening adverse reactions observed with large scale use of the drugs. The evaluation of the "minor" adverse effects was based on results of double blind comparative clinical studies.

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“…The PUVA therapy intercalates into the DNA double helix and generates highly mutagenic photoproducts which damp the rapidly dividing psoriatic epidermis down [28]. However, the immunosuppressive effects of UV radiation can contribute to malignant transformation [29][30][31][32].…”

Section: Puva Therapy and Phototherapy In Psoriasis: Pros And Consmentioning

confidence: 99%

“…Two separate modalities of the UVB phototherapy can be distinguished -the broadband therapy (BB UVB), available for more than 80 years and the newer narrowband UVB (NB UVB) with the radiation emission at 311 nm. NB UVB has been shown to be superior to BB UVB for a number of dermatoses [28,44]. The UVB phototherapy is widely considered as a safer alternative to the PUVA therapy [45].…”

Section: Puva Therapy and Phototherapy In Psoriasis: Pros And Consmentioning

confidence: 99%

Melanoma and other malignant skin cancers in psoriatic patients treated with phototherapy. Role of the p16 protein in psoriasis

Szponar-Bojda¹,

Pietrzak

Sobczyńska-Tomaszewska

et al. 2012

Folia Histochem Cytobiol.

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Abstract:Recently, the potential risk of malignant cancer development in psoriatic patients has been highlighted. However, the relationship between the therapeutic schemes in psoriasis and possible neoplastic transformation has not been so far clearly explained. Phototherapy is considered a very effective therapeutic method in psoriasis, however, the pathogenesis of some malignancies may be associated with the exposure to UV radiation. p16 protein belongs to the defense mechanisms that protect cells from damage and mutagenic factors, such as UV radiation. In recent years, the altered expression of the p16 protein in the diseases not related to malignant transformation, including psoriasis, has been observed. These new observations suggest participation of the p16 protein in the mechanisms of psoriatic plaque formation.

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Treatments for psoriasis and the risk of malignancy

Cited by 204 publications

References 113 publications

Incidence rates of malignancies and hospitalized infectious events in patients with psoriasis with or without treatment and a general population in the U.S.A.: 2005–09

Incidence rates of malignancies and hospitalized infectious events in patients with psoriasis with or without treatment and a general population in the U.S.A.: 2005–09

Biologicals in the Treatment of Plaque Psoriasis: Drug Selection by Means of the SOJA Method

Melanoma and other malignant skin cancers in psoriatic patients treated with phototherapy. Role of the p16 protein in psoriasis

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