Cutaneous malignancy after biologic therapy for inflammatory disease: An active comparator, retrospective cohort study.

BACKGROUND

The role biologics play in skin cancer among patients with inflammatory disease (ID) is uncertain. Skin cancer risk in patients with ID is elevated regardless of therapy, and there is a paucity of longitudinal data evaluating biologics that accounts for these ID-related confounders.

OBJECTIVE

To assess the risk of cutaneous malignancy after biologic therapy for ID using head-to-head comparisons to control confounding risks of ID.

METHODS

Data from 1,759,200 patients (2004-2024) with psoriasis, rheumatoid arthritis, and inflammatory bowel disease in the TriNetX network were analyzed. The risk of cutaneous malignancy was calculated after exposure to biologic therapy. Propensity score matching was implemented to control for confounders.

RESULTS

A total of 212,632 (12.1%) patients were prescribed biologics for ID. Risk analysis demonstrated a small but significant elevation in absolute risk of nonmelanoma skin cancer driven predominately by patients exposed to tumor necrosis factor inhibitors. No other agents analyzed individually demonstrated significant risk elevations.

LIMITATIONS: Limitations include a retrospective approach and inherent errors/underreporting in electronic medical records.

CONCLUSION

This study confirms the association of tumor necrosis factor inhibitors with nonmelanoma skin cancer. Other biologics including interleukin and Janus kinase inhibitors may contribute minimally to skin cancer risk in ID. These differences underscore the care and personalized approach necessary in biologic selection for patients with ID.