Cutaneous malignancy after biologic therapy for inflammatory disease: An active comparator, retrospective cohort...

Area of Science:

• Dermatology
• Rheumatology
• Gastroenterology
• Oncology

Background:

• The association between biologic therapies and skin cancer risk in patients with inflammatory diseases (ID) remains unclear.
• Patients with ID have an inherent elevated risk of skin cancer, independent of treatment.
• Limited longitudinal data exist that adequately control for ID-related confounding factors when evaluating biologic safety.

Purpose of the Study:

• To evaluate the risk of developing cutaneous malignancy following biologic therapy for inflammatory diseases.
• To conduct head-to-head comparisons of different biologics to mitigate confounding risks associated with the underlying inflammatory disease.

Main Methods:

• Analysis of a large dataset (1,759,200 patients) from the TriNetX network (2004-2024) including patients with psoriasis, rheumatoid arthritis, and inflammatory bowel disease.
• Calculation of cutaneous malignancy risk following exposure to various biologic therapies.
• Application of propensity score matching to control for potential confounding variables.

Main Results:

• Approximately 12.1% of patients (212,632) received biologic therapy for their inflammatory condition.
• A statistically significant, though small, increase in the absolute risk of nonmelanoma skin cancer was observed, primarily associated with tumor necrosis factor (TNF) inhibitors.
• No significant increase in skin cancer risk was identified for other individual biologic agents studied.

Conclusions:

• The study confirms a link between TNF inhibitors and an increased risk of nonmelanoma skin cancer.
• While other biologics like interleukin and Janus kinase inhibitors may pose a minimal risk, the findings emphasize the need for personalized biologic selection in managing inflammatory diseases.
• Limitations include the retrospective nature of the study and potential data inaccuracies inherent in electronic medical records.