Lymphoma Rates Are Low but Increased in Patients With Psoriasis

Gelfand, Joel M.; Berlin, Jesse A.; Voorhees, Abby Van; Margolis, David J.

doi:10.1001/archderm.139.11.1425

Cited by 231 publications

(37 citation statements)

References 38 publications

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“…Patients with psoriasis are more likely to develop LPD [31,32,33], and the incidence of LPD in the external psoriasis cohorts (SH and UHC) was slightly higher than that in the external general population (SEER; 0.02 per 100 patient years). It is difficult to determine whether the increased risk in patients with psoriasis is due to the severity of the disease or to the systemic treatment itself [32] because PUVA and many systemic psoriasis medications are immunosuppressive [31], a known risk factor for developing lymphoma [28].…”

Section: Discussionmentioning

confidence: 99%

“…Lymphoproliferative disorders (LPD) and cutaneous malignancies, most notably squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and malignant melanoma, are of particular concern in patients receiving treatment for psoriasis. It is important to recognize that the risk of cutaneous malignancy [30] and LPD [31,32,33] appears to be greater in psoriatic patients than in the general population. Nonmelanoma skin cancer (NMSC), which encompasses cutaneous malignancies such as BCC and SCC, has a standardized incidence ratio (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…Compared with the general population, the incidence of non-Hodgkin’s lymphoma and Hodgkin’s disease was increased among 5,687 patients hospitalized for psoriasis [31]. In a retrospective cohort comparison of patients 65 years or older in the UK, psoriasis patients had an incidence of lymphoma nearly 3-fold that observed in patients who did not have psoriasis [33]. Numerous studies have evaluated the incidence of malignancy in patients with psoriasis in an effort to more completely understand the factors predisposing those patients to an elevated risk compared with the general population.…”

Section: Introductionmentioning

confidence: 99%

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A Review of Malignancies Observed during Efalizumab (Raptiva®) Clinical Trials for Plaque Psoriasis

Toth¹,

Cather²,

Langley³

et al. 2006

Dermatology

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Background: Psoriasis is a chronic, incurable immune-mediated disease. Most therapies used for moderate to severe psoriasis are immunosuppressive. Agents that depress immune function, including traditional psoriasis therapies, have been associated with an increased incidence of malignancies. Efalizumab is a recombinant monoclonal immunoglobulin G1 (IgG1) antibody approved for use in psoriasis patients. Objectives: To evaluate the incidence of malignancy in patients receiving efalizumab during clinical trials compared with placebo-treated patients, psoriasis patients from external cohorts and the general US population. Methods: Patient data were pooled from multiple phase III placebo-controlled, open-label efalizumab clinical trials, and the incidence rate of reported malignancies was calculated as a function of patient years of observation. The results for the efalizumab-treated patients were compared with the data on psoriasis patients from insurance claims databases and a registry of events in the general population. Results: The efalizumab- and placebo-treated patients had similar incidence rates of malignancy, including lymphoproliferative disease, solid tumor, malignant melanoma and nonmelanoma skin cancer. The incidence of nonmelanoma skin cancers, including basal cell carcinoma and squamous cell carcinoma, in patients receiving efalizumab or placebo was elevated relative to the external databases. Conclusions: These results suggest that efalizumab treatment does not increase a patient’s risk for malignancy. The difference observed with nonmelanoma skin cancer may be due to biases introduced by the clinical trial methodology. Additional patient observation is necessary to ascertain whether a link exists between efalizumab therapy and nonmelanoma skin cancer above that normally observed in psoriasis patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Review of Malignancies Observed during Efalizumab (Raptiva®) Clinical Trials for Plaque Psoriasis

Toth¹,

Cather²,

Langley³

et al. 2006

Dermatology

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“…[9][10][11][12][13][14][15][16] Among patients with psoriasis using systemic therapies, there is as much as a 50% greater risk for all malignancies when excluding NMSC and lymphoproliferative malignancies, a 4-fold increased relative risk of NMSC, and an 8-times greater risk of lymphoproliferative malignancies. [10][11][12][13][14][15][16] Among patients with autoimmune inflammatory conditions such as psoriasis, the incidence of serious infectious events (SIEs) is increased among those using antipsoriatic treatments. [17][18][19][20] Some studies suggest lower rates among patients < 65 years old compared with patients aged 65 and older.…”

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confidence: 99%

Incidence rates of malignancies and hospitalized infectious events in patients with psoriasis with or without treatment and a general population in the U.S.A.: 2005–09

et al. 2014

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SummaryBackground Rates of malignancies and hospitalized infectious events (HIEs) among psoriasis patients are higher than in the general population, but it is unclear if higher rates are associated with the underlying inflammatory state, treatments or both. Objectives To assess the incidence of malignancies and HIEs in a healthy US population, a psoriasis population, and four treated psoriasis populations. Methods Using a US claims database, we identified a general population, a psoriasis cohort, and four treatment cohorts [non-biologic systemics, etanercept, other TNF blockers (adalimumab, infliximab) and phototherapy] to assess the incidence of lymphomas, nonmelanoma skin cancer (NMSC), all malignancies (excluding NMSC), and HIEs, standardized for age and sex. Results Among 40 987 patients with psoriasis, 11% were prescribed non-biologics, 15% etanercept, 6% other TNF blockers and 11% phototherapy. For all cancers, the psoriasis population rate (114/10 000 person-years) was 20% greater than the rate found in the general population (95/10 000 person-years). For NMSC, the psoriasis population rate (129/10 000 person-years) was 65% greater than the general population rate (78/10 000 person-years). The incidence rate for each treatment modality was lower than the overall psoriasis cohort, except for phototherapy. There was little difference in the rates of lymphomas. NMSC rates were higher among patients treated with phototherapy. HIE rates ranged from 165/10 000 person-years for the phototherapy group to 262/10 000 person-years for the other anti-TNF group. Conclusions Patients with psoriasis appear to have higher rates of malignancy and HIE than the general population, with little difference in rates between the treatment methods, except for a higher rate of cancer among those receiving phototherapy.

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“…Psoriasis patients are at increased risk of developing malignancies such as malignant tumors [6] and lymphoma [7]. Given the presumed long-term use in combination with the immunosuppressive nature of most systemic psoriasis drugs, it is important to analyze the contribution of different treatments to that risk.…”

Section: Spontaneous Reporting Of Side Effectsmentioning

confidence: 99%

Psoriasis Therapy in Real Life: The Need for Registries

Schmitt‐Egenolf

2006

Dermatology

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The introduction of new therapeutic options for the management of psoriasis is a challenge for the dermatology community, and new tools are needed to face this challenge. This article argues for the establishment of profession-based registries to collect solid, long-term data on the safety and effectiveness of different psoriasis treatment regimens. Managed by health care professionals, registries will be most successful if they enroll patients based on indications for treatment rather than on drugs given. This protects the evaluation process from commercial influences and allows a fair comparison of old- versus new-generation psoriasis treatments. In contrast to the patients in a registry who receive care in the natural clinical setting, subjects in randomized clinical trials (RCTs) are selected according to study criteria and may therefore not reflect the experience of patients in clinical practice. It is possible that particular risks and opportunities in the real patient population may therefore go undetected in RCTs.

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Lymphoma Rates Are Low but Increased in Patients With Psoriasis

Cited by 231 publications

References 38 publications

A Review of Malignancies Observed during Efalizumab (Raptiva®) Clinical Trials for Plaque Psoriasis

A Review of Malignancies Observed during Efalizumab (Raptiva®) Clinical Trials for Plaque Psoriasis

Incidence rates of malignancies and hospitalized infectious events in patients with psoriasis with or without treatment and a general population in the U.S.A.: 2005–09

Psoriasis Therapy in Real Life: The Need for Registries

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