People with psoriasis are at increased risk for nonmelanoma skin cancers (NMSC) and melanoma. Conventional immunosuppressants and TNF-α inhibitors may further increase skin malignancies, while the risks associated with other biologics are less clear. This study aimed to determine skin malignancy risks in psoriasis patients treated with cyclosporine, methotrexate, TNF-α inhibitors, IL-12/23, IL-17, and IL-23 inhibitors.
Methods
Using the TriNetX database, psoriasis patients without skin cancer risk factors who received at least 2 years or at least 5 years of systemic treatment were compared with non-systemically treated psoriasis patients. Cyclosporine, methotrexate, and TNF-α inhibitors were also compared with other psoriasis biologics. NMSC and melanoma over 2 and 5 years were evaluated using multivariable Cox proportional hazards.
Results
Compared with non-systemically treated psoriasis patients, cyclosporine, methotrexate, TNF-α inhibitors, and the IL-12/23 inhibitor showed increased NMSC risk, whereas IL-17 inhibitors demonstrated a reduced risk. Compared with patients treated with cyclosporine, methotrexate, and TNF-α inhibitors, both IL-17 and IL-23 inhibitors demonstrated a reduced NMSC risk. Only cyclosporine was associated with elevated melanoma risk. The present study is limited by unmeasured factors, including psoriasis severity, ultraviolet radiation exposure, medication adherence, and dosing.
Conclusions
Systemic therapies for psoriasis vary in skin malignancy risk, with IL-17 and IL-23 inhibitors having the lowest NMSC risk.  .
