INTRODUCTION
Psoriasis is a chronic inflammatory condition affecting the skin.1,2 Pathophysiology involves Th1- and Th17-driven inflammation with consequently increased levels of TNF-α, IL-17, and IL-23.3 Patients with psoriasis are at increased risk of nonmelanoma skin cancer (NMSC);4,5 and the risk is increased with more severe psoriasis.6,7 Melanoma risk is also increased, with melanoma being associated with mild psoriasis in one study5 and with severe psoriasis in another study.6 This cancer association persists in patients treated without systemic therapies,5,6 indicating that a risk exists independent of immunosuppressive drugs. Still, conventional immunosuppressants such as cyclosporine and methotrexate appear to confer an additional risk of skin cancer.8-10 While this association has not been fully elucidated in psoriasis patients specifically, the association between these drugs and malignancy serves as an established touchstone.
The new age of biologics has revolutionized psoriasis treatment. Generally, biologic treatment of psoriasis has not been shown to increase melanoma risk.11 Furthermore, psoriasis registry studies have shown no increased risk of solid and hematologic malignancies in psoriasis patients on biologics. Specifically, studies on patients in the Psoriasis Longitudinal Assessment and Registry (PSOLAR) taking methotrexate, TNF-α inhibitors, and ustekinumab have explored the overall malignancy rate but, importantly, excluded NMSC.12,13 Thus, the risk of cutaneous NMSC associated with newer biologics remains insufficiently explored. This risk is especially important to determine because IL-17 and IL-23 inhibitors are the most efficacious psoriasis treatment classes,14,15 so patients who have failed less effective drugs may be switched to IL-17 and IL-23 agents.
Using a large, international database, the present study seeks to quantify the risk of developing skin cancer in patients with psoriatic disease being treated with systemic therapies.
The new age of biologics has revolutionized psoriasis treatment. Generally, biologic treatment of psoriasis has not been shown to increase melanoma risk.11 Furthermore, psoriasis registry studies have shown no increased risk of solid and hematologic malignancies in psoriasis patients on biologics. Specifically, studies on patients in the Psoriasis Longitudinal Assessment and Registry (PSOLAR) taking methotrexate, TNF-α inhibitors, and ustekinumab have explored the overall malignancy rate but, importantly, excluded NMSC.12,13 Thus, the risk of cutaneous NMSC associated with newer biologics remains insufficiently explored. This risk is especially important to determine because IL-17 and IL-23 inhibitors are the most efficacious psoriasis treatment classes,14,15 so patients who have failed less effective drugs may be switched to IL-17 and IL-23 agents.
Using a large, international database, the present study seeks to quantify the risk of developing skin cancer in patients with psoriatic disease being treated with systemic therapies.
MATERIALS AND METHODS
This study used the TriNetX (TriNetX LLC, Cambridge, MA) proprietary patient database, which contained aggregated
