The risk of malignancy in patients with psoriasis treated with long-term tumour necrosis factor-alpha inhibitors: a systematic review and meta-analysis.
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Abstract
Background: The relationship between tumour necrosis factor-alpha inhibitors (TNFis) and cancer risk is complex, given their pivotal role in managing chronic inflammatory conditions. Persistent concerns about TNFi therapy potentially increasing cancer risk necessitate a thorough understanding of its long-term effects on cancer development in patients with psoriasis to guide therapeutic decision making.
Objectives: To evaluate the association between long-term TNFi therapy and cancer risk in patients with psoriasis in a systematic review and meta-analysis.
Methods: Data were collected from PubMed, Embase and the Cochrane Library, from their inception to 1 January 2024. The studies included adults with psoriasis or psoriatic arthritis receiving an TNFi, presenting standardized incidence ratio (SIR) data for cancer. Data extraction followed PRISMA guidelines, with independent extraction by two authors, and pooled data synthesis was conducted using a random-effects model. The primary outcomes were SIRs for all cancers excluding nonmelanoma skin carcinoma (NMSC) and for NMSC itself. The secondary outcome was SIRs for specific cancer types.
Results: We reviewed 13 studies, including 8 new studies and 5 from a previous meta-analysis. Of the 13 studies, only 8 were included in the meta-analysis comprising a total of 32 765 patients with psoriasis. The pooled results showed no increased risk of cancers for the categories: all cancers excluding NMSC; melanoma; lymphoma; prostate cancer; and breast cancer among individuals receiving long-term TNFi therapy for psoriasis compared with the general population. However, subgroup analysis found an elevated risk of NMSC in patients with psoriatic arthritis and a significant increase in the risk of squamous cell carcinoma (SCC) among patients with psoriasis treated with TNFis compared with the general population [SIR 1.84, 95% confidence interval (CI) 1.16-2.92 and SIR 2.84, 95% CI 1.64-4.91, respectively].
Conclusions: Our systematic review and meta-analysis indicate that most cancers examined did not demonstrate an increased risk following long-term TNFi therapy in patients with psoriasis. However, for patients with psoriatic arthritis or those at high risk of SCC, these findings underscore the importance of personalized treatment strategies that weigh individual risks and benefits.
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