An increased risk of non-melanoma skin cancer during TNF-inhibitor treatment in psoriasis patients compared to rheumatoid arthritis patients probably relates to disease-related factors
Conflicts of interest:
P.P.M. van Lümig carried out clinical trials for Abbott and Janssen-Cilag. P.P.M. van Lümig has received speaking and consulting fees from Wyeth and Schering-Plough and has received reimbursement for attending conferences from Schering-Plough, Pfizer and Janssen. S.P. Menting carried out clinical trials for Abbvie, Amgen, Janssen-Cilag and Pfizer. J.M.P.A. van den Reek carries out clinical trials for Abbott and Janssen and has received reimbursement for attending a symposium from Janssen and Abbott. J.M.P.A. van den Reek has received speaking fees from Abbott. P.I. Spuls has in the past received an unrestricted grant from Schering-Plough and Leo-Pharma, served as consultant for AbbVie, Leopharma and Novartis and was and is involved in clinical trials funded by Abbott, Schering-Plough, Merck Serono, Pfizer, Wyeth, Centocor, Celgene, Astellas, Amgen, Leopharma and Janssen-Cilag. P.L.C.M. van Riel was involved in studies funded by Pfizer, Roche, Abbott, BMS, UCB and MSD. P.C.M. van de Kerkhof serves as a consultant for Schering-Plough, Celgene, Centocor, Allmirall, Amgen, Pfizer, Abbott, Actelion, Galderma, Novartis, Janssen and LEO-Pharma. He carries out clinical trials for Centocor, Pfizer, Schering-Plough, Merck Serono, Abbott and Philips Lighting. J. Fransen has no conflicts of interest to declare. W. Kievit has no conflicts of interest to declare. E.M.G.J. de Jong has acted as consultant and/or paid speaker and/or participated in research sponsored by companies that manufacture drugs used for the treatment of psoriasis including Abbott, Janssen-Cilag, MSD and Pfizer.
Funding sources:
This was an investigator initiated study. The Radboud university medical center was supported in part by UMC St Radboud Foundation, who received funding from Wyeth Pharmaceuticals for the project. Wyeth Pharmaceuticals played no role in the design and conduct of the study, data collection, data management, data analysis, interpretation of the data, manuscript preparation, manuscript review, manuscript approval or publication decisions. The data of the Academic Medical Center in Amsterdam were retrieved without funding.
Abstract
Background
Concerns exist about a risk of non-melanoma skin cancer (NMSC) in psoriasis patients and rheumatoid arthritis (RA) patients treated with TNF-inhibitors. However, current data also show that in some psoriasis patients, NMSC is diagnosed relatively short after the start of TNF-inhibitors, which suggests that these NMSC can be explained by previous therapies instead of by TNF-inhibitor therapy.
Objective
To investigate whether there was a difference in time until first NMSC and the rate of NMSC between psoriasis and RA patients on TNF-inhibitors.
Methods
Time until first NMSC and the rate of NMSC were compared between psoriasis and RA patients from the same region treated with TNF-inhibitors and followed up for at least one year in prospective cohort studies, by using Cox regression and Poisson regression. Both analyses were corrected for confounders (age, gender, disease duration, prior NMSC, duration of anti-TNF and other systemic therapies).
Results
The NMSC risk was significantly higher in the psoriasis group [fully adjusted HR 6.0 (1.6–22.4 95%CI)] with a shorter time until first NMSC in psoriasis compared to RA. By Poisson regression, psoriasis patients had a 5.5 (2.2–13.4 95%CI) higher rate of NMSC.
Conclusion
The time until first NMSC was significantly shorter and the rate of NMSC was significantly higher in psoriasis compared with RA. This indicates that disease-related factors like phototherapy may be important contributing factors to NMSC diagnosed in psoriasis patients treated with TNF-inhibitors.
