Safety of biologic therapy in psoriasis patients with a previous malignancy: Retrospective study using TriNetX

Area of Science:

• Dermatology
• Oncology
• Pharmacology

Background:

• Limited evidence exists for treating psoriatic disease (PsO) in patients with a history of malignancy.
• Psoriatic disease patients with prior cancer require careful consideration of systemic therapy risks.

Purpose of the Study:

• To compare the incidence of new neoplasms in PsO patients with prior malignancy treated with conventional systemic therapies, apremilast, or biologic agents.
• To evaluate the safety and efficacy of different systemic treatments in a high-risk PsO population.

Main Methods:

• Retrospective observational study utilizing the TriNetX database.
• Included PsO patients (ICD10:L40) with a prior cancer diagnosis (ICD10:C00-D49) within 5 years of systemic therapy initiation.
• Outcomes assessed were new neoplasm documentation and all-cause mortality over 3 years.

Main Results:

• Biologic therapy was associated with significantly lower rates of new neoplasms and all-cause mortality compared to conventional agents and apremilast.
• Tumor necrosis factor inhibitors (TNFi) showed a significantly lower new neoplasm rate versus conventional agents; all biologics reduced mortality.
• Interleukin-23 inhibitors (IL-23i) uniquely lowered cancer recurrence risk compared to TNFi, with similar mortality rates.

Conclusions:

• Biologic therapy for PsO appears safe in patients with a history of malignancy, offering advantages over conventional therapies and apremilast.
• Among biologics, IL-23 inhibitors present the most favorable safety profile for this patient group.