Psoriasis Therapy and Skin Cancer: A Review
Abstract
:1. Introduction
2. Methods
3. Chronic Inflammation and Increased Risk of Skin Cancer
4. Risk of NMSC and Melanoma in Psoriasis
4.1. NMSC
4.2. Melanoma
5. Skin Lymphoma in Psoriasis
6. Risk of Skin Cancer in Others Cutaneous and Not Cutaneous Autoinflammatory Diseases
7. Psoriasis Therapies and Skin Cancer
7.1. Chronic Use of Topical and Oral Corticosteroids
7.2. UVB Therapy (PUVA, NBUVB, and BBUVB)
7.3. Classic Systemic Drugs (MTX, Cyclosporine, Acitretin, Fumaric Acid Esters)
7.4. Biologic Treatment (TNFi, Anti-IL12/23, Anti-IL17A/IL17R, Anti-IL23)
7.5. New Therapies in Psoriasis (JAK-Inhibitors, Apremilast)
8. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Therapies | Reference | Number of Patients | Cancer Risk Estimated | ||
---|---|---|---|---|---|
NMSC | Melanoma | ||||
PUVA (>200) | Stern et al. 2001 [50] (>200 PUVA treatments) | 1380 | - | IRR = 8.4; 95% (3.4–17.3) Increased risk of melanoma in patients treated with PUVA | |
Stern et al. 2012 [29] (>350 PUVA treatments) | 1380 | SCC: IRR = 6.01, 95% (4.41–8.20) BCC: IRR = 3.09, 95% (2.36–4.06) Exposure to more than 350 PUVA treatments greatly increases the risk of SCC | |||
Hearn et al. 2008 [51] (>100 PUVA treatments) | 3867 (24,753 PY) | SCC: IRR 2.06; 95% (0.89–4.73) BCC: IRR 1.66, 95% (0.24–9.80) | CMM: IRR = 4.43; 95% (0.69–48.99) | ||
No significant association among NB-UVB treatment and BCC, SCC, or melanoma | |||||
NBUVB | Man et al. 2005 [52] | 1908 | SCC: SRR = 149; 95% (18–539); p > 0.05. BCC: SRR = 213; 95% (102–391); p < 0.05) No increased risk of SCC in patients treated with NBUVB compared with general Scottish population A small but significant increase of BCC. | CMM: SRR = 187 95% (23–675) No increased risk of melanoma in patients treated with NBUVB compared to the general Scottish population | |
Hearn et al. 2008 [51] | 3867 (24,753 PY) | SCC: IRR 2.04 95% (0.17–17.82) BCC: IRR 1.22 95% (0.28–4.25) | CMM: IRR = 1,02 95% (0.019–12.73) | ||
No association was found between NB-UVB exposure alone (>100 NB-UVB treatments) (without PUVA) and any skin cancer. For NB-UVB and PUVA treated patients, there was an association with BCC, with 27 BCCs found, compared to 14.1 expected in the matched population | |||||
Maren W. et al. 2004 [53] | 126 (726 PY) | - | No evidence for increased skin cancer risk for patients treated with NBUVB phototherapy | ||
MTX | Stern et al. 1997 [29] | 80 patients with NMSC and 297 matched controls | - | RR = 1.2 (upper bound 95% confidence interval = 1.9) MTX does not increase the risk of cutaneous malignancy | |
Buchbinder et al. 2008 [54] | 459 (4145 PY) | - | SIR = 3.0, 95% (1.2–6.2). Compared with the general population, patients with RA treated with MTX have an increased incidence of melanoma | ||
S. Polesie et al. 2020 [17] | 395 patients with psoriasis who had previously been cancer-free and had a first CMM | - | OR = 1.0, 95% (0.8–13). No risk of CMM | ||
CsA | Paul et al. 2003 [38] | 1252 (PY 4377) | BCC: IR = 1.1/1000 PY; 95% (0.4–2.6). SCC: IR = 1.2/1000 PY; 95% (1.9–5.6). Increased risk of NMSC associated with cyclosporine treatment, mostly SCC | IR = 0.5/1000 PY; 95% (0.1–1.6). No risk of CMM | |
Adalimumab | Leonardi et al. 2011 [43] | 3727 (5429.9 PY) | BCC: SIR = 1.24; 95% (0.8–1.83) SCC: SMR = 3.03; 95% (1.61–5.17). No risk of NMSC associated with adalimumab treatment | - | |
Etanercept | Pariser et al. 2012 [55] | 4410 (4775.1 PY) | BCC: SIR: 0.55; 95% (0.37–0.80) SCC: SIR: 1.78; 95% (1.11–2.69). SIR for NMSC did not achieve statistical significance | - | |
Biologics combined | Asgari et al. 2017 [56] | 2285 (9211 PY) | BCC: aHR = 1.23 (0.91–1.66) SCC: aHR = 1.81; 95% (1.23–2.67) | - | |
Mason et al. 2018 [57] | 5672 (20558 PY) | BCC: aHR = 0.84; 95% (0.45–1.54) SCC: aHR = 1.20; 95% (0.57–2.50) | |||
deShazo et al. (Psolar) [12] | TNFi | TNFi + ustekinumab: 7955 Increased risk of NMSC in patients with biologics therapies. | BCC: aHR = 2.54 (1.08–5.98) SCC: aHR = 0.91; 95% (0.41.95) | - | |
Ustekinumab | BCC: aHR = 1.35; 95% (0.49–3.67) SCC: aHR = 0.30; 95% (0.10–0.90) | ||||
Tofacitinib | Burmester et al. 2020 [49] | 783 (776 PY) | NMSC: IR = 0.5; 95% (0.1–1.3) No increased risk of NMSC associated with tofacitinib | - |
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Butrón-Bris, B.; Daudén, E.; Rodríguez-Jiménez, P. Psoriasis Therapy and Skin Cancer: A Review. Life 2021, 11, 1109. https://doi.org/10.3390/life11101109
Butrón-Bris B, Daudén E, Rodríguez-Jiménez P. Psoriasis Therapy and Skin Cancer: A Review. Life. 2021; 11(10):1109. https://doi.org/10.3390/life11101109
Chicago/Turabian StyleButrón-Bris, Beatriz, Esteban Daudén, and Pedro Rodríguez-Jiménez. 2021. "Psoriasis Therapy and Skin Cancer: A Review" Life 11, no. 10: 1109. https://doi.org/10.3390/life11101109
APA StyleButrón-Bris, B., Daudén, E., & Rodríguez-Jiménez, P. (2021). Psoriasis Therapy and Skin Cancer: A Review. Life, 11(10), 1109. https://doi.org/10.3390/life11101109