To Sheng-Yin, Lee Cho-Hao, Chen Yi-Hsien, Hsu Chia-Lu, Yang Hui-Wen, Jiang Ying-Shan, Wen Yuan-Liang, Chen I-Wen, Kao Li-Ting
Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.
JAMA Dermatol. 2025 Jan 1;161(1):31-38. doi: 10.1001/jamadermatol.2024.4129.
Immune checkpoint inhibitors (ICIs) are recognized as revolutionary cancer therapies but have raised concerns about immune-related adverse events, including the development of autoimmune diseases.
To evaluate the psoriasis risk associated with the use of ICIs in patients with cancer.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide cohort study with a target trial emulation design used data from the Taiwan National Health Insurance database and the Taiwan Cancer Registry. The participants included were patients who received antineoplastic medications for cancer at stages III and IV between January 1, 2019, and June 30, 2021. Data were analyzed from May 2023 to July 2024.
Patients treated with ICIs were classified as ICI users, while those who received chemotherapy or targeted therapies were categorized as non-ICI users.
The primary outcome was the incidence of psoriasis during the follow-up period. Stabilized inverse probability of treatment weighting (IPTW) was used to mitigate potential confounders. Cox and Fine-Gray hazard models were used to calculate hazard ratios (HRs) for psoriasis risk between groups.
Of 135 230 patients who received antineoplastic medications (mean [SD] age, 62.94 [13.01] years; 45.1% female), 3188 patients were eligible for the ICI user group, while 132 042 patients were eligible for the non-ICI user group. ICI users experienced a higher incidence of psoriasis at 5.76 cases per 1000 person-years, compared to 1.44 cases in the non-ICI group. After adjusting for demographics and comorbidities, ICI users were found to have a 2-fold increase in the risk of developing psoriasis (IPTW-adjusted HR, 3.31; IPTW-adjusted subdistribution HR, 2.43). Both as-started design and on-treatment design showed consistent findings, and the results were consistent and robust across all follow-up intervals and all sensitivity analyses.
In this cohort study, patients with cancer treated with ICIs faced an increased risk of psoriasis. Medical professionals should be aware of the potential adverse effects of immunotherapy to ensure optimal cancer care.
免疫检查点抑制剂（ICIs）被认为是革命性的癌症治疗方法，但引发了人们对免疫相关不良事件的担忧，包括自身免疫性疾病的发生。
评估癌症患者使用ICIs与银屑病风险之间的关联。
设计、设置和参与者：这项具有目标试验模拟设计的全国性队列研究使用了台湾国民健康保险数据库和台湾癌症登记处的数据。纳入的参与者为2019年1月1日至2021年6月30日期间接受III期和IV期癌症抗肿瘤药物治疗的患者。数据于2023年5月至2024年7月进行分析。
接受ICIs治疗的患者被分类为ICI使用者，而接受化疗或靶向治疗的患者被分类为非ICI使用者。
主要结局是随访期间银屑病的发病率。使用稳定的逆概率治疗加权法（IPTW）来减轻潜在的混杂因素。使用Cox和Fine-Gray风险模型计算两组之间银屑病风险的风险比（HRs）。
在135230例接受抗肿瘤药物治疗的患者中（平均[标准差]年龄，62.94[13.01]岁；45.1%为女性），3188例患者符合ICI使用者组的条件，而132042例患者符合非ICI使用者组的条件。ICI使用者的银屑病发病率较高，为每1000人年5.76例，而非ICI组为1.44例。在调整人口统计学和合并症后，发现ICI使用者患银屑病的风险增加了2倍（IPTW调整后的HR，3.31；IPTW调整后的亚分布HR，2.43）。起始设计和治疗中设计均显示出一致的结果，并且在所有随访间隔和所有敏感性分析中结果都是一致且稳健的。
在这项队列研究中，接受ICIs治疗的癌症患者面临银屑病风险增加的情况。医学专业人员应意识到免疫治疗的潜在不良反应，以确保最佳的癌症治疗。
