Safety of biologic therapy in psoriasis patients with a previous malignancy: Retrospective study using TriNetX

BACKGROUND AND OBJECTIVES: Evidence-based recommendations for the treatment of patients with psoriatic disease (PsO) and a prior history of malignancy are limited. This study aimed to compare the incidence of newly diagnosed neoplasms among patients with PsO and a previous malignancy receiving treatment with conventional systemic therapies, apremilast, or biologic agents. PATIENTS AND METHODS: Retrospective observational study using TriNetX. PsO patients (ICD10:L40) with a previous diagnosis of cancer (ICD10:C00-D49) less than 5 years prior to systemic therapy initiation were selected. Outcomes evaluated included new documentation of neoplasms and all-cause mortality. RESULTS: Patients under biologic therapy had a significantly lower new neoplasm documentation rate and all-cause mortality compared to classical agents (HR 0.857 and HR 0.705, respectively) and apremilast (HR 0.782 and HR 0.803, respectively) at 3 years follow-up. Only TNFi exhibited a significantly lower new neoplasm rate (HR 0.867, p < 0.0001) compared to classical agents; however, all biologic agents significantly decreased mortality. IL-23i was the only biologic therapy to significantly lower cancer recurrence risk (RR 0.878) compared to TNFi, with no differences in all-cause mortality. CONCLUSIONS: Biologic therapy for PsO may represent a safe treatment option in patients with a history of malignancy, compared with conventional systemic therapies or apremilast. Among biologic agents, IL-23 inhibitors appear to be associated with the most favorable safety profile.