Kimball AB, Schenfeld J, Accortt NA, Anthony MS, Rothman KJ, Pariser D. Cohort study of malignancies and hospitalised infectious events in treated and untreated patients with psoriasis and a general population in the United States. Br J Dermatol. 2015 Nov;173(5):1183-90. doi: 10.1111/bjd.14068

BACKGROUND: Psoriasis is associated with risk of malignancy. Some psoriasis treatments may increase risk of hospitalised infectious events (HIEs).

To evaluate rates of malignancies and HIEs in psoriasis patients.

METHODS: This retrospective cohort study utilised data from MarketScan® databases. Cohorts included: adult general population (GP), psoriasis patients, and psoriasis patients treated with nonbiologics, adalimumab, etanercept, infliximab, or phototherapy. Outcomes included incidence rates (IRs) per 10,000 person-years observation (PYO) for all malignancies excluding nonmelanoma skin cancer (NMSC), lymphoma, NMSC, and per 10,000 person-years exposure (PYE) for HIEs.

IRs (95% confidence interval [CI]) for all malignancies except NMSC were 129 (127, 130) and 142 (135, 149) for GP (PYO=51,071,587) and psoriasis (PYO=119,432) cohorts, respectively; 10.9 (10.5, 11.3) and 12.9 (10.9, 14.8) for lymphoma; and 145 (144, 147) and 180 (173, 188) for NMSC. Rates for all malignancies excluding NMSC were similar among treatments but variable for lymphoma and NMSC. IRs (95% CI) for HIEs were 332 (256, 408) for the nonbiologic cohort (PYE=3,528); 288 (206, 370) for etanercept (PYE=6,563); 325 (196, 455) for adalimumab (PYE=2,772); 521 (278, 765) for infliximab (PYE=1,058); and 334 (242, 427) for phototherapy (PYE=1,797). IRs for HIEs were lowest for etanercept and higher in patients on baseline systemic corticosteroids across treatment cohorts.

CONCLUSION: Malignancy rates were higher in psoriasis patients than the GP, but these treatments did not appear to increase malignancy risk.

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