26549 Risk of malignancy associated with medication use in elderly patients with psoriasis

Abstract

Psoriasis is a chronic systemic inflammatory disease linked to several comorbidities, including malignancy. Elderly patients are at high risk for developing malignancy, which may influence screening and treatment decisions. A retrospective cohort study was conducted using administrative health care data. Individuals 70 years and older diagnosed with psoriasis (cases, n = 42,684) across a period of 13 years were sex- and age-matched to controls (n = 430,002). The prevalence of malignancy was 27.54% in cases and 18.43% in controls. The relative risk (RR) of malignancy in cases compared with controls was 1.49 (95% CI 1.47-1.52), increasing to 1.80 (95% CI 1.75-1.85) after excluding individuals with history of cancer. In cases with concurrent psoriatic arthritis, the RR of malignancy compared with those without was 1.33 (95% CI 1.25-1.41), increasing to 1.52 (95% CI 1.37-1.68) after excluding individuals with history of cancer. The RR of malignancy associated with medication use was also investigated, excluding individuals with history of cancer. Compared with controls, cases had an increased RR of malignancy if they were treated with methotrexate (RR 1.74, 99.6% CI 1.54-1.96), phototherapy (RR 1.76, 99.6% CI 1.53-2.02), or infliximab (RR 2.14, 99.6% CI 1.04-4.42). There was no statistically significant association between medication use and risk of malignancy for patients on cyclosporine, etanercept, adalimumab, golimumab, certolizumab pegol, ustekinumab, or anti-interleukin-17s. When comparing cases exposed to a certain therapy to those not exposed, no therapy studied carried a statistically significant risk of malignancy. When managing psoriasis in the elderly, it is important to consider the increased risk of malignancy.