Individuals with Cancer Treated with Immune Checkpoint Inhibitors at Risk for Psoriasis

Credit: Pixabay

Patients who have cancer and are treated with immune checkpoint inhibitors (ICIs) are at an increased risk of developing psoriasis, according to new findings, and possible adverse immunotherapy effects may require additional attention.¹

These results represent the conclusion of new research published in JAMA and authored by a team led by Sheng-Yin To, BS, RPh, from the Graduate Institute of Life Sciences at the National Defense Medical Center in Taiwan.

To et al. sought to evaluate immune checkpoint inhibitors and how they may be linked to the incidence of psoriasis among patients with cancer. They noted that new analyses had been deemed necessary to assess the adverse effects of psoriasis and that existing datasets could be useful to achieve a more rigorous observational analysis.²

“This study aimed to investigate the subsequent risk of psoriasis in ICI users compared with those receiving chemotherapy or targeted therapies in patients with cancer using a nationwide database that emulated target trials,” To and colleagues wrote.¹

Trial Design Details

The investigative team sourced their analysis’ data from Taiwan’s National Health Insurance (NHI) database as well as the Taiwan Cancer Registry (TCR), both of which are managed by the Health and Welfare Data Science Center under the Ministry of Health and Welfare.

The nationwide TCR cancer registry gathers data from 214 hospitals, with oncologists mainly responsible for submission of pathological, laboratory, clinical, imaging, and personal patient data, as well as information on primary site, cancer staging, treatment, diagnosis, and follow-up care. The NHI program was designed as a compulsory health insurance system and their NHI database provides comprehensive claims data in addition to detailed records regarding outpatient and inpatient services.

The research team looked at information from cancer patients in these databases receiving stage III and IV antineoplastic medications in the timeframe between January 2019 - June 2021, and their data analysis was carried out from May 2023 - July 2024. They divided the subjects into ones treated with ICIs and those given chemotherapy or targeted therapies.

The investigators' main outcome which they evaluated was the noted incidence of psoriasis by the follow-up period. In order to account for any confounders, the team utilized stabilized inverse probability of treatment weighting (IPTW). They calculated hazard ratios (HRs) for risk between the cohorts through Cox and Fine-Gray hazard models.

Major Findings

There were 3,188 individuals placed into the ICI arm of the study, while 132,042 were placed in the non-ICI arm. The researchers concluded that among 135,230 participants who had been treated with antineoplastic medications, the mean age of subjects was shown to be 62.94 years.

The investigative team also noted that 45.1% of them had been female. In their results, it was shown that there was a higher rate of psoriasis noted among the ICI users. Specifically, the investigators reported 5.76 cases per 1,000 person-years, compared to 1.44 cases in the non-ICI cohort.

When the research team adjusted for comorbidity and demographic factors, they concluded that ICI users had twice the risk of psoriasis development compared to non-ICI individuals (IPTW-adjusted HR, 3.31; IPTW-adjusted subdistribution HR, 2.43). They added that the data showed consistency across various analyses and designs, with robust results being demonstrated throughout all follow-up intervals as well as sensitivity checks.

“Although this adverse effect is relatively uncommon, it is important for medical professionals, clinicians, and caregivers to be aware of this potential risk to improve skin health and ensure optimal cancer care,” they wrote.¹

References

1. ^{To S, Lee C, Chen Y, et al. Psoriasis Risk With Immune Checkpoint Inhibitors. JAMA Dermatol. Published online November 06, 2024. doi:10.1001/jamadermatol.2024.4129.}
2. ^{Szmulewicz AG. Target trial emulation in psychiatry: a call for more rigorous observational analyses. Lancet Psychiatry. 2024;11(7):492-494. doi:10.1016/S2215-0366(24)00104-4.}