Table 1.
Studies assessing the risk of developing any NMSC, BCC, and melanoma in patients with psoriasis treated with different therapies.
| 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 |
- | |
Abbreviations: NMSC: non-melanoma skin cancer; BCC: basal cell carcinoma; SCC: squamous cell carcinoma; TNFi: tumor necrosis factor-alpha inhibitors; PY: patient years; IRR: incidence rate ratio; SRR: standardized rate ratio; OR: Odd ratio; SIR: standardized incidence rate; aHR: adjusted hazard ratio; SMR: standardized mortality rate.