JAMA Dermatology

<jats:sec id="ab-doi240048-4"><jats:title>Importance</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-doi240048-5"><jats:title>Objective</jats:title><jats:p>To evaluate the psoriasis risk associated with the use of ICIs in patients with cancer.</jats:p></jats:sec><jats:sec id="ab-doi240048-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-doi240048-7"><jats:title>Exposures</jats:title><jats:p>Patients treated with ICIs were classified as ICI users, while those who received chemotherapy or targeted therapies were categorized as non-ICI users.</jats:p></jats:sec><jats:sec id="ab-doi240048-8"><jats:title>Main Outcome and Measures</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-doi240048-9"><jats:title>Results</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="ab-doi240048-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>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.</jats:p></jats:sec>

Dissecting the mechanisms of immune checkpoint therapy.

Nat Rev Immunol

Immune checkpoint inhibitors: a promising anticancer therapy.

Drug Discov Today

Estimation of the percentage of US patients with cancer who are eligible for and respond to checkpoint inhibitor immunotherapy drugs.

JAMA Netw Open

Tumour- and class-specific patterns of immune-related adverse events of immune checkpoint inhibitors: a systematic review.

Ann Oncol

Immune-related adverse events after immune check point inhibitors: understanding the intersection with autoimmunity.

Immunol Rev

Immunotherapy in patients with autoimmune disease.

J Thorac Dis

Autoimmune complications of immunotherapy: pathophysiology and management.

Immune-related adverse events associated with immune checkpoint blockade.

N Engl J Med

Immune-related adverse events of checkpoint inhibitors.

Nat Rev Dis Primers

Treatment goals in psoriasis: which outcomes matter most?

Am J Clin Dermatol

Psoriasis: an epidemiological evaluation of disease burden in 590 patients.

J Eur Acad Dermatol Venereol

Pathophysiology, clinical presentation, and treatment of psoriasis: a review.

JAMA

Pathogenesis of psoriasis and development of treatment.

J Dermatol

PD-1 blockade augments Th1 and Th17 and suppresses Th2 responses in peripheral blood from patients with prostate and advanced melanoma cancer.

J Immunother

Activated circulating T follicular helper cells are associated with disease severity in patients with psoriasis.

J Immunol Res

Target trial emulation in psychiatry: a call for more rigorous observational analyses.

Lancet Psychiatry

Benefits and risks associated with statin therapy for primary prevention in old and very old adults: real-world evidence from a target trial emulation study.

Ann Intern Med

Nationwide population science: lessons from the Taiwan National Health Insurance Research Database.

JAMA Intern Med

Quality assessment and improvement of nationwide cancer registration system in Taiwan: a review.

Jpn J Clin Oncol

Validity of cancer diagnosis in the National Health Insurance database compared with the linked National Cancer Registry in Taiwan.

Pharmacoepidemiol Drug Saf

Cancer trends in Taiwan.

Target trial emulation: a framework for causal inference from observational data.

Exploring the rising incidence of neuroendocrine tumors: a population-based analysis of epidemiology, metastatic presentation, and outcomes.

Cancer

Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies.

Stat Med

Use of stabilized inverse propensity scores as weights to directly estimate relative risk and its confidence intervals.

Value Health

An introduction to inverse probability of treatment weighting in observational research.

Clin Kidney J

Persistence and adherence to biologics in patients with psoriasis in Taiwan: a new biologics user cohort study.

Front Pharmacol

Lifetime risk, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for psoriasis in Taiwan: a nationwide cohort followed from 2000 to 2017.

Ther Adv Chronic Dis

Target trial emulation: applying principles of randomised trials to observational studies.

Per-protocol analyses of pragmatic trials.

Immune checkpoint-mediated psoriasis: a multicenter European study of 115 patients from the European Network for Cutaneous Adverse Event to Oncologic Drugs (ENCADO) group.

J Am Acad Dermatol

Psoriasis and psoriasiform reactions secondary to immune checkpoint inhibitors.

Dermatol Ther

Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update.

J Clin Oncol

FDA-approved small-molecule kinase inhibitors.

Trends Pharmacol Sci

Cutaneous side-effects of kinase inhibitors and blocking antibodies.

Lancet Oncol

The emergence of supportive oncodermatology: the study of dermatologic adverse events to cancer therapies.

The safety and side effects of monoclonal antibodies.

Nat Rev Drug Discov

Target trial emulation to improve causal inference from observational data: what, why, and how?

J Am Soc Nephrol

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.
To evaluate the psoriasis risk associated with the use of ICIs in patients with cancer.
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.
Patients treated with ICIs were classified as ICI users, while those who received chemotherapy or targeted therapies were categorized as non-ICI users.
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.
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.
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.

Psoriasis Risk With Immune Checkpoint Inhibitors.

Psoriasis Risk With Immune Checkpoint Inhibitors

Psoriasis Risk With Immune Checkpoint Inhibitors

Clinical Summary

What was studied

Key findings

Clinical implications

Related Questions