Cancer risk after long-term exposure to interleukin (IL)-23 inhibitors (IL-23i) and IL-17 inhibitors (IL-17i) remains to be delineated.
To evaluate the risk of malignancies in patients with psoriasis treated with IL-23i and IL-17i relative to those prescribed tumor necrosis factor inhibitors (TNFi) during the first 5 years following drug initiation.
A global population-based cohort study included two distinct analyses comparing patients with psoriasis under different therapeutic modalities; (i) new users of IL-17i(n=15,331) versus TNFi(n=15,331) and (ii) new users of IL-23i(n=5,832) versus TNFi(n=5,832).
Patients prescribed IL-17i experienced a decreased risk of non-Hodgkin lymphoma (NHL; HR, 0.58; 95% CI, 0.40-0.82; P=0.002), colorectal cancer (HR, 0.68; 95% CI, 0.49-0.95; P=0.024), hepatobiliary cancer (HR, 0.68; 95% CI, 0.58-0.80; P<0.001), ovary cancer (HR, 0.48; 95% CI, 0.29-0.81; P=0.005), melanoma (HR, 0.52; 95% CI, 0.37-0.73; P<0.001), and basal cell carcinoma (BCC; HR, 0.57; 95% CI, 0.48-0.67; P<0.001). IL-23i was associated with a reduced risk of NHL (HR, 0.39; 95% CI, 0.19-0.78; P=0.006), hepatobiliary cancer (HR, 0.44; 95% CI, 0.31-0.62; P<0.001) and BCC (HR, 0.76; 95% CI, 0.57-0.99; P=0.046). In a sensitivity analysis comparing patients managed by IL-17i and IL-23i with their biologic-naïve counterparts, these classes were associated with decreased risk of several malignancies.
IL-17i and IL-23i are associated with decreased risk of several malignancies. These findings should be considered prior to the prescription of biologics. This article is protected by copyright. All rights reserved.