Stanford University School of Medicine, Palo Alto, California.
University of British Columbia, Vancouver, British Columbia, Canada.
J Am Acad Dermatol. 2017 Nov;77(5):845-854.e5. doi: 10.1016/j.jaad.2017.07.013. Epub 2017 Sep 8.
The effect of systemic therapy on malignancy risk among patients with psoriasis is not fully understood.
Evaluate the impact of systemic treatment on malignancy risk among patients with psoriasis in the Psoriasis Longitudinal Assessment and Registry (PSOLAR).
Nested case-control analyses were performed among patients with no history of malignancy. Cases were defined as first malignancy (other than nonmelanoma skin cancer) in the Psoriasis Longitudinal Assessment and Registry, and controls were matched by age, sex, geographic region, and time on registry. Study therapies included methotrexate, ustekinumab, and tumor necrosis factor-α (TNF-α) inhibitors. Exposure was defined as 1 or more doses of study therapy within 12 months of malignancy onset and further stratified by duration of therapy. Multivariate conditional logistic regression, adjusted for potential confounders, was used to estimate odds ratios of malignancies associated with therapy.
Among 12,090 patients, 252 malignancy cases were identified and 1008 controls were matched. Treatment with methotrexate or ustekinumab for more than 0 months to less than 3 months, 3 months to less than 12 months, or 12 months or longer was not associated with increased malignancy risk versus no exposure. Longer-term (≥12 months) (odds ratio, 1.54; 95% confidence interval, 1.10-2.15; P = .01), but not shorter-term treatment, with a TNF-α inhibitor was associated with increased malignancy risk.
Cases and controls could belong to 1 or more therapy categories.
Long-term (≥12 months) treatment with a TNF-α inhibitor, but not methotrexate and ustekinumab, may increase risk for malignancy in patients with psoriasis.
全身治疗对银屑病患者恶性肿瘤风险的影响尚不完全清楚。
在银屑病纵向评估和登记处（PSOLAR）中评估全身治疗对银屑病患者恶性肿瘤风险的影响。
在无恶性肿瘤病史的患者中进行嵌套病例对照分析。病例定义为银屑病纵向评估和登记处中的首次恶性肿瘤（非黑色素瘤皮肤癌除外），对照则按年龄、性别、地理区域和登记时间匹配。研究治疗包括甲氨蝶呤、乌司奴单抗和肿瘤坏死因子-α（TNF-α）抑制剂。暴露定义为在恶性肿瘤发病前 12 个月内接受 1 次或多次研究治疗，进一步按治疗持续时间分层。使用多变量条件逻辑回归，调整潜在混杂因素，估计与治疗相关的恶性肿瘤的比值比。
在 12090 名患者中，确定了 252 例恶性肿瘤病例和 1008 例对照。与无暴露相比，接受甲氨蝶呤或乌司奴单抗治疗 0 至<3 个月、3 至<12 个月或 12 个月或更长时间与恶性肿瘤风险增加无关。与短期（<12 个月）治疗相比，长期（≥12 个月）（比值比，1.54；95%置信区间，1.10-2.15；P=.01）使用 TNF-α抑制剂与恶性肿瘤风险增加相关。
病例和对照可能属于 1 种或多种治疗类别。
与甲氨蝶呤和乌司奴单抗相比，长期（≥12 个月）使用 TNF-α抑制剂可能会增加银屑病患者的恶性肿瘤风险。
