Malignancy rates in a large cohort of patients with systemically treated psoriasis in a managed care population - 18/04/17
, G. Thomas Ray, MBA a, Jamie L. Geier, PhD c, Charles P. Quesenberry, PhD aAbstract |
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).
Limitations |
No information was available on disease severity.
Conclusion |
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.
Le texte complet de cet article est disponible en PDF.Key words : basal cell carcinoma, biologics, cancer, cutaneous squamous cell carcinoma, epidemiology, nonmelanoma skin cancer, psoriasis, tumor necrosis factor-alfa
Abbreviations used : aHRs, BCC, CI, cSCC, KPNC, NMSC, SEER, SNOMED
Plan
| This research was funded by a grant from Pfizer Inc. |
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| Disclosure: Drs Asgari and Quesenberry have research contracts with Valeant. Mr Ray has had research funding from Merck. Dr Geier is an employee and shareholder of Pfizer Inc. |
Vol 76 - N° 4
P. 632-638 - avril 2017 Retour au numéro
Article précédent
- Clinical characteristics associated with days to discharge among patients admitted with a primary diagnosis of lower limb cellulitis
- Amit Garg, Jonathan Lavian, Gloria Lin, Cristina Sison, Michael Oppenheim, Bonnie Koo
- The risk of melanoma and hematologic cancers in patients with psoriasis
- Shivani P. Reddy, Kathryn Martires, Jashin J. Wu
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