Risk of cancer in patients with psoriasis on biological therapies: a systematic review. (18th December 2017)

• Record Type: Journal Article
• Authors: Peleva, E.; Exton, L.S.; Kelley, K.; Kleyn, C.E.; Mason, K.J.; Smith, C.H.
• Is Part Of: British journal of dermatology. Volume 178:Number 1(2018)
• Page Start: 103
• Page End: 113
• Publication Date: 2017-12-18
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.15830
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background: Biological therapies are highly effective in psoriasis, but have profound effects on innate and adaptive immune pathways that may negatively impact on cancer immunosurveillance mechanisms. Objectives: To investigate the risk of cancer in patients with psoriasis treated with biological therapy. Methods: We searched MEDLINE, Embase, and the Cochrane Library (up to August 2016) for randomized controlled trials, prospective cohort studies and systematic reviews that reported cancer incidence in people exposed to biological therapy for psoriasis compared with a control population. Results: Eight prospective cohort studies met our inclusion criteria. All the evidence reviewed related to tumour necrosis factor inhibitors (TNFi) with the exception of one study on ustekinumab. An increased risk of nonmelanoma skin cancer (NMSC), particularly squamous cell carcinoma, was reported with TNFi compared with both a general United States population and a rheumatoid arthritis population treated with TNFi. No evidence for increased risk of cancers (reported as all cancers, lymphoma, melanoma, prostate, colorectal and breast cancer) other than NMSC was identified. Conclusions: There were important limitations to the studies identified including choice of comparator arms, inadequate adjustment for confounding factors and failure to account for latency periods of cancer. There remains a need for ongoing pharmacovigilance in relation to cancer risk and biological therapy; the NMSC signal requires further investigation to determine the risk specifically attributable to biological therapy using prospectively collected data with adjustment for known NMSC risk factors. Abstract : What's already known about this topic? The risk of cancer in biologics‐exposed patients with psoriasis is poorly understood. While the risk is reasonably well characterized in other chronic autoimmune conditions, these findings cannot be extrapolated to patients with psoriasis. What does this study add? This systematic review summarizes the current literature for cancer risk in biologics‐exposed patients with psoriasis. Signals are emerging that exposure to tumour necrosis factor inhibitors is associated with increased risk of nonmelanoma skin cancers in people with psoriasis, but comparator groups identified were historic and studies lack adjustment for highly relevant confounding factors such as prior phototherapy. Long‐term pharmacovigilance is still required to establish whether there is a risk of cancer directly attributable to biological therapy. Linked Comment: Naldi. Br J Dermatol 2018; 178 :19 . Plain language summary available online