Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Dermatol Ther. 2022 Nov;35(11):e15804. doi: 10.1111/dth.15804. Epub 2022 Sep 13.
Large-scale, real-world studies on the side effects of systemic therapies (including biologics) in patients with psoriasis are limited. We aimed to calculate the risk of malignancy in patients with psoriasis who were treated with systemic medications. Nested case-control analyses were performed among psoriasis patients without a history of malignancy. We recruited 4188 patients with newly diagnosed psoriasis and successive malignancies, and 8376 matched controls from the National Health Insurance Research Database in Taiwan. The therapy duration was within 5 years before malignancy onset and further stratified into two groups according to the duration of medication usage. Multivariate conditional logistic regression adjusted for potential confounders was used to estimate malignancy risk associated with systemic treatments. Among psoriasis patients, long-term (> 12 months) treatment with cyclosporine increased the risk of malignancy compared with no exposure (odds ratio, 1.57; p = 0.01). Short-term (≤ 12 months) or long-term (> 12 months) use of other systemic treatments, including methotrexate, azathioprine, systemic retinoids, mycophenolate mofetil, sulfasalazine, etanercept, adalimumab, and ustekinumab, was not associated with an increased risk of malignancy in patients with psoriasis. Long-term treatment with cyclosporine increased the risk of malignancy in patients with psoriasis by 1.57-fold.
大规模的、真实世界的研究表明，银屑病患者的系统性治疗（包括生物制剂）副作用有限。我们旨在计算接受系统性药物治疗的银屑病患者发生恶性肿瘤的风险。在无恶性肿瘤病史的银屑病患者中进行了巢式病例对照分析。我们从台湾全民健康保险研究数据库中招募了 4188 名新诊断为银屑病且患有连续恶性肿瘤的患者和 8376 名匹配对照。治疗持续时间在恶性肿瘤发病前 5 年内，并根据药物使用时间进一步分为两组。采用多变量条件逻辑回归调整潜在混杂因素，以估计与系统性治疗相关的恶性肿瘤风险。在银屑病患者中，与无暴露相比，长期（>12 个月）使用环孢素治疗增加了恶性肿瘤的风险（优势比，1.57；p=0.01）。短期（≤12 个月）或长期（>12 个月）使用其他系统性治疗，包括甲氨蝶呤、硫唑嘌呤、全身类视黄醇、霉酚酸酯、柳氮磺胺吡啶、依那西普、阿达木单抗和乌司奴单抗，与银屑病患者恶性肿瘤风险增加无关。环孢素的长期治疗使银屑病患者的恶性肿瘤风险增加了 1.57 倍。
