Malignancy rates in a large cohort of patients with systemically treated psoriasis in a managed care population.
BACKGROUND
Moderate to severe psoriasis often requires treatment with systemic agents, many of which have immunosuppressive properties and could increase cancer risk, including nonmelanoma skin cancer (NMSC).


OBJECTIVE
We sought to estimate the overall malignancy rate (excluding NMSC) and NMSC rate among 5889 patients with systemically treated psoriasis.


METHODS
We identified a cohort of adult Kaiser Permanente Northern California health plan members with psoriasis diagnosed from 1998 to 2011 and treated with at least 1 systemic antipsoriatic agent and categorized them into ever-biologic or nonbiologic users. Malignancy rates were calculated per 1000 person-years of follow-up with 95% confidence intervals (CI). Crude and confounder-adjusted hazard ratios (aHRs) were calculated using Cox regression.


RESULTS
Most biologic-exposed members were treated with TNF-alfa inhibitors (n = 2214, 97%). Overall incident cancer rates were comparable between ever-biologic as compared to nonbiologic users (aHR 0.86, 95% CI 0.66-1.13). NMSC rates were 42% higher among individuals ever exposed to a biologic (aHR 1.42, 95% CI 1.12-1.80), largely driven by increased cutaneous squamous cell carcinoma risk (aHR 1.81, 95% CI 1.23-2.67).


CONCLUSIONS
No information was available on disease severity.


CONCLUSIONS
We found increased incidence of cutaneous squamous cell carcinoma among patients with systemically treated psoriasis who were ever exposed to biologics, the majority of which were TNF-alfa inhibitors. Increased skin cancer surveillance in this population may be warranted.
Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Dermatology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts. Electronic address: harvardskinstudies@partners.org.
Maryam M
MM
Asgari
Division of Research, Kaiser Permanente Northern California, Oakland, California.
G Thomas
GT
Ray
Pfizer Inc, New York, New York.
Jamie L
JL
Geier
Division of Research, Kaiser Permanente Northern California, Oakland, California.
Charles P
CP
Quesenberry
D000328:Adult; D000367:Age Factors; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D002140:California / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003879:Dermatologic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000209:etiology; D016016:Proportional Hazards Models; D011565:Psoriasis / Q000188:drug therapy* / Q000453:epidemiology / Q000532:radiotherapy; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014467:Ultraviolet Therapy / Q000009:adverse effects; D055815:Young Adult
D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha
basal cell carcinoma; biologics; cancer; cutaneous squamous cell carcinoma; epidemiology; nonmelanoma skin cancer; psoriasis; tumor necrosis factor-alfa