K.W. Hagberg and colleagues published a very interesting and needed study: “Rates of Cancers and Opportunistic Infections in Patients With Psoriatic Arthritis Compared With Patients Without Psoriatic Arthritis.” They looked at a cohort of patients and compared them to matched controls “to assess the incidence of cancers (solid, hematologic, and nonmelanoma skin cancer) and opportunistic infections”. The results are important for decisions in treatment.
Conclusions: “The rates of solid and nonmelanoma skin cancers were similar in patients with PsA compared with patients without PsA, but the rates of hematologic cancer and opportunistic infections were higher in patients with PsA. In patients with PsA, rates of all outcomes were higher among those who received prescriptions for systemic PsA therapy.”
But let’s have a closer look.
The PsA cohort showed a higher rate of hematologic cancer than the non-PsA cohort. The highest incidence rates ratios (IRRs) were in the group of patients under immunosuppressants (IRR: 6.79); patients under DMARDs and biologics (IRR: 3.59) and patients under other drugs (IRR: 3.50) showed comparable IRRs.
The rates of solid cancer and nonmelanoma skin cancer were similar in both the PsA and non-PsA cohort. The highest IRR has been estimated for patients under corticosteroids (IRR: 4.19).
The IRs (incidence rates) for opportunistic infections were higher in the PsA group. Patients under drugs (e.g. NSAIDs), DMARDs/TNFi or immunosuppressants showed IRRs from 1.65 to 1.88, patients under corticosteroids showed an IRR of 5.07 however. If you look at the results of the German registry for biologics in RA patients (RABBIT) you also find the highest rate of infections in patients treated with corticosteroids with a clear dose dependency.
My conclusion: in patients with psoriatic arthritis we need to be very cautious with corticosteroids.
K.W. Hagberg and colleagues: “Rates of Cancers and Opportunistic Infections in Patients With Psoriatic Arthritis Compared With Patients Without Psoriatic Arthritis.” J Clin Rheumatol. 2016 Aug;22(5):241-7. doi: 10.1097/RHU.0000000000000364. http://www.ncbi.nlm.nih.gov/pubmed/26886439