Risk of malignancy in patients with psoriasis according to treatment modalities in Korea: a nationwide cohort study

Abstract

Intrinsic immunologic disparity of psoriasis itself, along with chronic inflammation and immunomodulatory anti-psoriatic treatments could be associated with increased risk of malignancy. We aimed to estimate the risk of malignancy in patients with psoriasis by treatment modality compared with that in individuals without psoriasis in Korea. We conducted a nationwide cohort study using the claims database of the National Health Insurance Service from January 2005 to December 2018. A total of 255,471 patients with psoriasis, and age- and sex-matched non-psoriasis participants (1:1 ratio) were enrolled. The adjusted hazard ratios (aHRs) [95% confidence intervals (CIs)] for malignancy without nonmelanoma skin cancer (NMSC) were 1.10 [1.08-1.12] in patients with psoriasis, 1.13 [1.00-1.27], 1.05 [0.97-1.13], and 1.24 [0.84-1.83] in phototherapy, non-biologic systemics, and biologics cohort, respectively. Among the non-biologic systemics cohort, patients treated with cyclosporin showed higher risk of malignancy without NMSC (aHR [95% CI], 1.20 [1.04-1.39]). The risk of malignancy without NMSC in patients with psoriasis was higher than that in individuals without psoriasis. Phototherapy and biologics were not associated with significant increase of risk; however, cyclosporin appeared to increase its risk. Dermatologists should be vigilant about this potential risk while managing patients with psoriasis.

Figure 1

Incidence probabilities for psoriasis and non-psoriasis participants according to anti-psoriatic treatments. Comparison of Kaplan–Meier curve on malignancy without NMSC between (a) psoriasis and non-psoriasis participants and (b) psoriasis according to anti-psoriatic treatments and non-psoriasis participants. IL-12/23, interleukin-12/23; NMSC, nonmelanoma skin cancer; TNF-α, tumor necrosis factor-α.

Figure 2

Risk of malignancy without NMSC in patients with psoriasis according to subcohorts of anti-psoriatic treatments compared with non-psoriasis participants. ^†Adjusted for age, sex, BMI, smoking status, family history of malignancy, Charlson Comorbidity Index, and alcohol use disorder (F10). ^‡Adjusted for age, BMI, smoking status, family history of malignancy, Charlson Comorbidity Index, and alcohol use disorder (F10). ^§The null hypothesis was rejected at false discovery rate adjusted P-value of 0.05. aHR, adjusted hazard ratio; BMI, body mass index; CI, confidence interval; CNS, central nervous system; IL-12/23, interleukin-12/23; NMSC, nonmelanoma skin cancer; TNF-α, tumor necrosis factor-α; w/o, without.