Abstract
Purpose
To assess cancer risks in patients with psoriasis and the effect of TNF-α inhibitor and interleukin (IL)-12/23 inhibitor therapy on those cancer risks.
Methods
Using the Korean Health Insurance Review and Assessment Service database, patients with newly diagnosed psoriasis between 2008 to 2019 were included. Standardized incidence ratios (SIRs) of overall and specific cancers were calculated in patients with psoriasis. The effect of TNF-α inhibitor and IL-12/23 inhibitor exposure on the risk of cancers was assessed by multivariable Cox regression models.
Results
In total, 191,678 patients with psoriasis were included in this study. The overall risk of cancer was significantly higher in patients with psoriasis than in the general population (SIR, 1.12; 95% confidence interval (CI), 1.09–1.14). TNF-α inhibitor users had a significantly higher risk for overall cancer (adjusted hazard ratio (aHR), 1.41; 95% CI 1.01–1.97). In contrast, IL-12/23 inhibitor exposure had a significantly lower risk for overall cancer (aHR, 0.57; 95% CI 0.37–0.87). Among specific cancers, the risks of non-Hodgkin lymphoma (aHR, 2.98; 95% CI 1.02–8.69) were increased by TNF-α inhibitor therapy, while the risk of other cancers, including nonmelanoma skin cancer (aHR, 2.31; 95% CI 0.51–10.46), was not significantly altered by TNF-α inhibitor therapy.
Conclusion
TNF-α inhibitor therapy in psoriasis is associated with a significantly increased risk of overall cancer and lymphoma, while the risk of solid organ cancer was not affected by this therapy. The IL-12/23 inhibitor is not associated with an increased risk of any cancer.
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Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Acknowledgements
We thank the Korean Health Insurance Review and Assessment Service and the National Health Insurance Service for providing the insurance claims data.
Funding
This study was supported by a grant, the ‘Elimination of Cancer Project Fund’, from the Asan Cancer Institute of Asan Medical Center, Seoul, Korea and the National Research Foundation of Korea (NRF) Grant funded by the Korea government (MSIT) (NRF-2018R1C1B6003389). This study was also supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number : HR20C0026 and HI20C1586).
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JMJ, CHW, and WJL had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design, data acquisition, data analysis/interpretation, drafting manuscript, critical revision of manuscript, and final approval: JMJ, YJK, SEC, MWL, CHW, and WJL. Statistical analysis: JMJ and YJK. Technical support: YJK and WJL. Supervision: CH Won and WJL.
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The Institutional Review Board of Asan Medical Center approved this study (2021-0377).
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Jung, J.M., Kim, YJ., Chang, S.E. et al. Cancer risks in patients with psoriasis administered biologics therapy: a nationwide population-based study. J Cancer Res Clin Oncol 149, 17093–17102 (2023). https://doi.org/10.1007/s00432-023-05387-6
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DOI: https://doi.org/10.1007/s00432-023-05387-6