Cyclosporin may increase malignancy risk in psoriasis

In psoriasis patients, treatment with cyclosporin may increase the risk of malignancy without nonmelanoma skin cancer (NMSC), a recent study has found. Biologic or phototherapy have no such impact.

Researchers conducted a nationwide cohort analysis of 255,471 patients whose data were retrieved from the National Health Insurance Service of Korea. Participants were matched 1:1 according to age and sex with nonpsoriasis controls. The outcomes of interest were new onset of malignant neoplasms and in-situ neoplasms, excluding NMSC.

Of the psoriasis patients, most (n=244,380) were treated with nonsystemic drugs. Those who had been treated systemically were further divided into three according to the therapeutic agent: phototherapy (n=2,881), biologics (n=532), and nonbiologic systemics (n=7,678). Cyclosporin was defined as a nonbiologic systemic drug.

Both nonsystemic (adjusted hazard ratio [HR], 1.07, 95 percent confidence interval [CI], 1.00–1.14) and systemic (adjusted HR, 1.10, 95 percent CI, 1.08–1.12) psoriasis treatments were associated with an elevated risk of malignancy without NMSC, indicating that “patients with psoriasis might be at a higher risk of malignancy without NMSC than nonpsoriasis participants,” the researchers explained.

However, looking at the specific systemic therapies revealed that such effect was driven by cyclosporin (adjusted HR, 1.20, 95 percent CI, 1.04–1.39), particularly as regards haematologic (adjusted HR, 3.46, 95 percent CI, 1.90–6.30) and pancreatic (adjusted HR, 1.97, 95 percent CI, 1.25–3.10) cancers.

Biologic treatments (adjusted HR, 1.24, 95 percent CI, 0.84–1.83) and phototherapy (adjusted HR, 1.13, 95 percent CI, 1.00–1.27) were not correlated with increased cancer risk.