Psoriasis Risk With Immune Checkpoint Inhibitors.

IF 11.5 1区医学 Q1 DERMATOLOGY

JAMA dermatology Pub Date : 2024-11-06 DOI:10.1001/jamadermatol.2024.4129

Sheng-Yin To, Cho-Hao Lee, Yi-Hsien Chen, Chia-Lu Hsu, Hui-Wen Yang, Ying-Shan Jiang, Yuan-Liang Wen, I-Wen Chen, Li-Ting Kao

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引用次数: 0

Abstract

Importance: Immune checkpoint inhibitors (ICIs) are recognized as revolutionary cancer therapies but have raised concerns about immune-related adverse events, including the development of autoimmune diseases.

Objective: To evaluate the psoriasis risk associated with the use of ICIs in patients with cancer.

Design, setting, and participants: This nationwide cohort study with a target trial emulation design used data from the Taiwan National Health Insurance database and the Taiwan Cancer Registry. The participants included were patients who received antineoplastic medications for cancer at stages III and IV between January 1, 2019, and June 30, 2021. Data were analyzed from May 2023 to July 2024.

Exposures: Patients treated with ICIs were classified as ICI users, while those who received chemotherapy or targeted therapies were categorized as non-ICI users.

Main outcome and measures: The primary outcome was the incidence of psoriasis during the follow-up period. Stabilized inverse probability of treatment weighting (IPTW) was used to mitigate potential confounders. Cox and Fine-Gray hazard models were used to calculate hazard ratios (HRs) for psoriasis risk between groups.

Results: Of 135 230 patients who received antineoplastic medications (mean [SD] age, 62.94 [13.01] years; 45.1% female), 3188 patients were eligible for the ICI user group, while 132 042 patients were eligible for the non-ICI user group. ICI users experienced a higher incidence of psoriasis at 5.76 cases per 1000 person-years, compared to 1.44 cases in the non-ICI group. After adjusting for demographics and comorbidities, ICI users were found to have a 2-fold increase in the risk of developing psoriasis (IPTW-adjusted HR, 3.31; IPTW-adjusted subdistribution HR, 2.43). Both as-started design and on-treatment design showed consistent findings, and the results were consistent and robust across all follow-up intervals and all sensitivity analyses.

Conclusions and relevance: In this cohort study, patients with cancer treated with ICIs faced an increased risk of psoriasis. Medical professionals should be aware of the potential adverse effects of immunotherapy to ensure optimal cancer care.

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免疫检查点抑制剂的牛皮癣风险。

重要性：免疫检查点抑制剂（ICIs）是公认的革命性癌症疗法，但也引发了对免疫相关不良事件的担忧，包括自身免疫性疾病的发生：评估与癌症患者使用 ICIs 相关的银屑病风险：这项采用目标试验模拟设计的全国性队列研究使用了台湾国民健康保险数据库和台湾癌症登记处的数据。研究对象包括在 2019 年 1 月 1 日至 2021 年 6 月 30 日期间接受抗肿瘤药物治疗的 III 期和 IV 期癌症患者。数据分析时间为 2023 年 5 月至 2024 年 7 月：接受 ICIs 治疗的患者被归类为 ICI 使用者，而接受化疗或靶向治疗的患者被归类为非 ICI 使用者：主要结果和测量指标：主要结果是随访期间的银屑病发病率。采用稳定的逆治疗概率加权法（IPTW）来减少潜在的混杂因素。采用Cox和Fine-Gray危险模型计算组间银屑病风险的危险比（HRs）：在135230名接受抗肿瘤药物治疗的患者（平均[SD]年龄为62.94[13.01]岁；45.1%为女性）中，有3188名患者符合ICI使用者组的条件，而有132042名患者符合非ICI使用者组的条件。ICI 使用者的银屑病发病率较高，每千人年为 5.76 例，而非 ICI 组为 1.44 例。在对人口统计学和合并症进行调整后，发现 ICI 使用者患银屑病的风险增加了 2 倍（IPTW 调整后 HR，3.31；IPTW 调整后子分布 HR，2.43）。起始设计和治疗中设计均显示出一致的结果，所有随访间隔和所有敏感性分析的结果均一致且稳健：在这项队列研究中，接受 ICIs 治疗的癌症患者罹患银屑病的风险增加。医务人员应了解免疫疗法的潜在不良反应，以确保提供最佳的癌症护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JAMA dermatology DERMATOLOGY-

CiteScore

14.10

自引率

5.50%

发文量

300

期刊介绍： JAMA Dermatology is an international peer-reviewed journal that has been in continuous publication since 1882. It began publication by the American Medical Association in 1920 as Archives of Dermatology and Syphilology. The journal publishes material that helps in the development and testing of the effectiveness of diagnosis and treatment in medical and surgical dermatology, pediatric and geriatric dermatology, and oncologic and aesthetic dermatologic surgery. JAMA Dermatology is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications. It is published online weekly, every Wednesday, and in 12 print/online issues a year. The mission of the journal is to elevate the art and science of health and diseases of skin, hair, nails, and mucous membranes, and their treatment, with the aim of enabling dermatologists to deliver evidence-based, high-value medical and surgical dermatologic care. The journal publishes a broad range of innovative studies and trials that shift research and clinical practice paradigms, expand the understanding of the burden of dermatologic diseases and key outcomes, improve the practice of dermatology, and ensure equitable care to all patients. It also features research and opinion examining ethical, moral, socioeconomic, educational, and political issues relevant to dermatologists, aiming to enable ongoing improvement to the workforce, scope of practice, and the training of future dermatologists. JAMA Dermatology aims to be a leader in developing initiatives to improve diversity, equity, and inclusion within the specialty and within dermatology medical publishing.