Cohort study of malignancies and hospitalized infectious events in treated and untreated patients with psoriasis and a general population in the United States.
BACKGROUND
Psoriasis is associated with risk of malignancy. Some psoriasis treatments may increase the risk of hospitalized infectious events (HIEs).


OBJECTIVE
To evaluate rates of malignancies and HIEs in patients with psoriasis.


METHODS
This retrospective cohort study utilized data from MarketScan(®) databases. Cohorts included adult general population (GP), patients with psoriasis, and patients with psoriasis treated with nonbiologics, adalimumab, etanercept, infliximab or phototherapy. Outcomes included incidence rates (IRs) per 10 000 person-years observation (PYO) for all malignancies excluding nonmelanoma skin cancer (NMSC), lymphoma, NMSC, and per 10 000 person-years of exposure (PYE) for HIEs.


RESULTS
Incidence rates [95% confidence interval (CI)] for all malignancies except NMSC were 129 (127-130) and 142 (135-149) for GP (PYO = 51 071 587) and psoriasis (PYO = 119 432) cohorts, respectively; 10·9 (10·5-11·3) and 12·9 (10·9-14·8) for lymphoma; and 145 (144-147) and 180 (173-188) for NMSC. Rates for all malignancies excluding NMSC were similar among treatments but variable for lymphoma and NMSC. IRs (95% CI) for HIEs were 332 (256-408) for the nonbiologic cohort (PYE = 3528); 288 (206-370) for etanercept (PYE = 6563); 325 (196-455) for adalimumab (PYE = 2772); 521 (278-765) for infliximab (PYE = 1058); and 334 (242-427) for phototherapy (PYE = 1797). IRs for HIEs were lowest for etanercept and higher in patients on baseline systemic corticosteroids across treatment cohorts.


CONCLUSIONS
Malignancy rates were higher in patients with psoriasis than the GP, but these treatments did not appear to increase malignancy risk.
Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, #240, Boston, MA, 02114, U.S.A.
A B
AB
Kimball
DOCS Global, Inc., North Wales, PA, U.S.A.
J
J
Schenfeld
Amgen Inc., Thousand Oaks, CA, U.S.A.
N A
NA
Accortt
Amgen Inc., Thousand Oaks, CA, U.S.A.
M S
MS
Anthony
RTI International, Research Triangle Park, NC, U.S.A.
K J
KJ
Rothman
Eastern Virginia Medical School and Virginia Clinical Research, Inc., Norfolk, VA, U.S.A.
D
D
Pariser
D000068879:Adalimumab / Q000627:therapeutic use; D000328:Adult; D001685:Biological Factors / Q000627:therapeutic use; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D003879:Dermatologic Agents / Q000627:therapeutic use; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology; D010789:Phototherapy / Q000379:methods; D011565:Psoriasis / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D001685:Biological Factors; D003879:Dermatologic Agents; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept