The Risk Of Keratinocyte Carcinoma (KC) In Psoriasis Patients Receiving Biologic Therapy Compared To Conventional Systemic Therapy: Results From The British Association of Dermatologists Biologic Interventions Register (BADBIR)

Whether psoriasis patients exposed to biologic therapies have an elevated risk of KC (basal cell carcinoma [BCC] or cutaneous squamous cell carcinoma [cSCC]) remains uncertain. The aim of the present study was to determine whether such patients were at higher risk of developing a KC compared to those on conventional therapy.
BADBIR, a pharmacovigilance register of psoriasis patients, explores the long-term safety of systemic therapies. Patients with chronic plaque psoriasis registering to BADBIR on their first biologic or a conventional therapy, who had at least one follow-up completed were included in analyses if they were of white ethnicity, Fitzpatrick skin types 1-4 and reported no previous cancers. Confounding factors included: age; sex; smoking; and previous exposure to acitretin, psoralen ultraviolet-A (PUVA), ciclosporin, and/or PUVA and ciclosporin. Propensity score-weighted Cox-proportional hazard models estimated the hazard ratio (HR) for developing a first KC or separately, first BCC or cSCC.
In total, 5672 patients initiating biologic therapy and 3188 patients on conventional therapy who met the entry criteria were identified with 20558 and 7829 person-years of follow-up, respectively. During follow-up, 74 (1.3%) patients initiating a biologic therapy were diagnosed with their first KC (43 BCC; 34 cSCC first) and 22 (0.7%) patients receiving conventional therapy with their first KC (15 BCC; 10 cSCC first). No significant difference in risk was observed for developing a KC (adjusted HR 1.05; 95% CI 0.64, 1.73), BCC (0.84; 95% CI 0.45, 1.54) or cSCC (1.20; 95% CI 0.57, 2.50) on biologic compared to conventional therapy.
In conclusion, biologic therapy does not appear to confer a higher risk of developing a first KC as compared to conventional therapy in psoriasis patients. These data will help inform clinical decision making in psoriasis patients at risk of KC in whom biologic or conventional therapy is being considered.