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Is psoriasis or psoriatic arthritis associated with an increased risk of cancer?
In a systematic review and meta-analysis of 112 studies including more than 2 million patients, the risk of cancer overall was slightly increased in patients with psoriasis, particularly the risks of keratinocyte cancer and lymphomas. No increase in cancer was seen among patients with psoriasis treated with biologic agents, and psoriatic arthritis was not associated with an increased risk of cancer.
Patients with psoriasis appear to have a slightly increased risk of developing cancers.
The association between psoriasis and risk of cancer remains debatable.
To evaluate the association and risk of cancer in patients with psoriasis or psoriatic arthritis, including risk of specific cancer subtypes.
Two databases (PubMed and Embase) were screened from inception to January 1, 2019, using the search string psoriasis or psoriatic and neoplasms or malignancy or cancer. The search was filtered to only include human participants and publications in English.
Observational cohort studies with a population of patients with psoriasis or psoriatic arthritis were included. Studies had to be original and report the incidence or prevalence of cancer within this population. Studies evaluating pediatric populations and cancer types not included in the protocol were excluded.
Data Extraction and Synthesis
This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search string, objectives, and study protocol methods were defined before the study was initiated. A total of 365 studies were included for full-text assessment. Owing to the heterogeneity of the included studies, a random-effects model was used.
Main Outcomes and Measures
Main outcome was cancer (overall and specific subtypes) and measures were prevalence, incidence, and risk estimate for cancer in patients with psoriasis or psoriatic arthritis.
Of the 365 studies assessed, 112 were included in the analysis (N = 2 053 932 patients). The overall prevalence of cancer in patients with psoriasis was 4.78% (95% CI, 4.02%-5.59%), with an incidence rate of 11.75 per 1000 person-years (95% CI, 8.66-15.31) and a risk ratio (RR) of 1.21 (95% CI, 1.11-1.33). There was an increased risk of several cancers, including keratinocyte cancer (RR, 2.28; 95% CI, 1.73-3.01), lymphomas (RR, 1.56; 95% CI, 1.37-1.78), lung cancer (RR, 1.26; 95% CI, 1.13-1.40), and bladder cancer (RR, 1.12; 95% CI, 1.04-1.19). No increased risk of cancer for patients with psoriasis treated with biologic agents was found (RR, 0.97; 95% CI, 0.85-1.10). Psoriatic arthritis was not associated with increased risk of cancer overall (RR, 1.02; 95% CI, 0.97-1.08).
Conclusions and Relevance
Patients with psoriasis appear to have a slightly increased risk of cancer, particularly keratinocyte cancer and lymphomas. Data on treatment with biologic agents did not show an increased risk of cancer. Data on cancer in patients with psoriatic arthritis remain scarce, and further research is warranted in this area.
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Accepted for Publication: January 3, 2020.
Corresponding Author: Sofie Vaengebjerg, MD, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark (firstname.lastname@example.org).
Published Online: February 19, 2020. doi:10.1001/jamadermatol.2020.0024
Author Contributions: Dr Vaengebjerg had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Skov, Egeberg, Loft.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Vaengebjerg, Loft.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Egeberg.
Administrative, technical, or material support: All authors.
Supervision: Skov, Egeberg, Loft.
Conflict of Interest Disclosures: Dr Egeberg reported receiving grants, personal fees, and nonfinancial support from Eli Lilly, AbbVie, and Almirall; grants and personal fees from Pfizer and Janssen; personal fees from Novartis; and personal fees from Bristol-Myers Squibb, Samsung Bioepis, and UCB outside the submitted work. Dr Skov reported receiving personal fees from AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall, and Sanofi; and has received grants from Pfizer, AbbVie, Novartis, Sanofi, Janssen Cilag, and LEO Pharma outside the submitted work; was a paid speaker for AbbVie, Eli Lilly, Novartis, and LEO Pharma; has been a paid consultant or has served on advisory boards of AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall, and Sanofi; has served as an investigator for AbbVie, Janssen Cilag, Boehringer Ingelheim, AstraZeneca, Eli Lilly, Novartis, Regeneron, and LEO Pharma; and has received research and educational grants from Pfizer, AbbVie, Novartis, Sanofi, Janssen Cilag, and LEO Pharma. Dr Loft reported receiving personal fees from Eli Lilly outside the submitted work. No other disclosures were reported.
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