PATIENTS with psoriasis initiating biologic therapy, particularly tumor necrosis factor (TNF) inhibitors, may have a reduced long-term risk of developing primary malignancies compared with biologic-naïve individuals, according to a large retrospective cohort study.
Using a propensity score–matched design, researchers evaluated 32,230 patients with psoriasis who began treatment with an FDA-approved biologic. Participants were grouped by drug class: TNF inhibitors (n=16,011), IL-23 inhibitors (n=5,604), IL-12/23 inhibitors (n=3,856), and IL-17 inhibitors (n=5,467). Risk of developing a first malignancy within 10 years was compared with matched controls who had never received biologics.
TNF inhibitor recipients demonstrated a statistically significant reduction in the incidence of any primary malignancy (hazard ratio [HR]=0.80; 95% CI=0.73–0.87). Although similar risk reductions were observed among IL-23 inhibitors (HR=0.83; 95% CI=0.68–1.02), IL-12/23 inhibitors (HR=0.85; 95% CI=0.71–1.03), and IL-17 inhibitors (HR=0.87; 95% CI=0.73–1.04), these findings did not reach statistical significance.
Analysis by cancer subtype revealed that TNF inhibitor users were less likely to develop nonmelanoma skin cancer than biologic-naïve controls (HR=0.82; 95% CI=0.71–0.96). No significant differences in nonmelanoma skin cancer risk were observed for IL-23, IL-12/23, or IL-17 inhibitor cohorts. Furthermore, exposure to any biologic class was not associated with increased incidence of melanoma or lymphoid/hematopoietic malignancies.
The findings support the long-term oncologic safety of biologic therapies in psoriasis management, without increased melanoma or hematologic malignancy risk, with TNF inhibitors demonstrating the most consistent reduction in malignancy risk. The results may help inform long-term treatment decisions for clinicians managing patients with moderate-to-severe psoriasis.
Reference:
Ro C et al. Assessment of Primary Malignancy Risk after Initiation of Biologic Therapy in Patients with Psoriasis. JID Innov. 2025;5(6):100397.
