Risk of Cancer in Patients with Psoriasis on Biologic Therapies: A Systematic Review

Summary

Biologic therapies are highly effective in psoriasis, but have profound effects on innate and adaptive immune pathways that may negatively impact on cancer immunosurveillance mechanisms. To investigate the risk of cancer in psoriasis patients treated with biologic therapy we searched Medline, Embase, and the Cochrane Library (up to August 2016) for randomized control trials, prospective cohort studies and systematic reviews that reported cancer incidence in people exposed to biologic therapy for psoriasis compared to a control population. Eight prospective cohort studies met our inclusion criteria. All the evidence reviewed related to tumour necrosis factor inhibitors (TNFi) with the exception of one study on ustekinumab. An increased risk of non-melanoma skin cancer (NMSC), particularly squamous cell carcinoma, was reported with TNFi compared to both a general United States population and a rheumatoid arthritis population treated with TNFi. No evidence for increased risk of cancers (reported as all cancers, lymphoma, melanoma, prostate, colorectal and breast cancer) other than NMSC was identified. There were important limitations to the studies identified including choice of comparator arms, inadequate adjustment for confounding factors and failure to account for latency periods of cancer. There remains a need for ongoing pharmacovigilance in relation to cancer risk and biologic therapy; to determine whether the NMSC signal is specifically attributable to TNFi, further investigation is required using prospectively-collected data with adjustment for known NMSC risk factors. Systematic review registration number: PROSPERO; 2015:CRD42015017538.

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