Decreased Nonmelanoma Skin Cancer Risk With Interleukin-17 and Interleukin-23 Inhibitors Versus TNF-α Inhibitors in...

Area of Science:

• Dermatology
• Oncology
• Pharmacology

Background:

• Psoriasis patients have an elevated risk of nonmelanoma skin cancers (NMSC) and melanoma.
• Conventional immunosuppressants and TNF-alpha inhibitors may increase skin malignancy risk.
• Risks associated with newer biologics for psoriasis are less understood.

Purpose of the Study:

• To assess and compare the skin malignancy risks associated with various systemic psoriasis treatments.
• Evaluate risks for cyclosporine, methotrexate, TNF-alpha inhibitors, IL-12/23, IL-17, and IL-23 inhibitors.

Main Methods:

• Utilized the TriNetX database to compare systemically treated psoriasis patients (≥2 or ≥5 years) with non-systemically treated controls.
• Compared cyclosporine, methotrexate, and TNF-alpha inhibitors against other psoriasis biologics.
• Employed multivariable Cox proportional hazards models to evaluate NMSC and melanoma incidence over 2 and 5 years.

Main Results:

• Cyclosporine, methotrexate, TNF-alpha inhibitors, and IL-12/23 inhibitors were linked to increased NMSC risk versus no systemic treatment.
• IL-17 inhibitors showed a reduced NMSC risk.
• IL-17 and IL-23 inhibitors demonstrated lower NMSC risk compared to cyclosporine, methotrexate, and TNF-alpha inhibitors.
• Cyclosporine was the only agent associated with increased melanoma risk.

Conclusions:

• Systemic psoriasis therapies differ significantly in their associated skin malignancy risks.
• IL-17 and IL-23 inhibitors represent the safest options regarding NMSC risk in psoriasis patients.