BI09 Risk of skin cancer in solid organ transplant recipients prescribed biologics for psoriasis

Abstract

Chronic immunosuppressive therapy used in solid organ transplantation, and tumour necrosis factor (TNF)-α inhibitors used for psoriasis treatment are independently associated with an increased risk of cutaneous neoplasms. However, solid organ transplant recipients (SOTRs) are frequently excluded from clinical trials evaluating adverse outcomes of biologic treatment in this vulnerable group with coexisting inflammatory conditions like psoriasis. To address this gap, we investigated whether biologic therapies increase the risk of skin cancer in SOTRs with psoriasis. We used TriNetX to access deidentified charts of 4657 SOTRs with psoriasis between 2015 and 2025 in the USA. Cohorts were propensity score matched for demographics and skin cancer risk factors, resulting in a matched cohort of 414 patients. We calculated the risk for skin cancer diagnosis within 10 years following treatment with approved biologics for psoriasis compared with a matched biologic-naive control cohort. Relative risk and 95% confidence intervals were calculated according to the analytics package within TriNetX. We identified 456 SOTRs who received TNF-α inhibitors (n = 237), interleukin (IL)-17 inhibitors (n = 125), IL-23 inhib­itors (n = 142) and/or IL-12/23 inhibitors (n = 71). The risk for first-time skin cancer diagnosis in patients who received any biologic did not differ significantly from the biologic-naive cohort (any skin cancer: P = 0.22, melanoma: P = 0.66, nonmelanoma skin cancer: P = 0.18). Similar nonsignificant risks of skin cancer was seen in patients receiving TNF-α inhibitor monotherapy (any skin cancer: P = 0.24, melanoma: P > 0.99, nonmelanoma skin cancer: P = 0.23). The findings of this cohort study suggest that biologic therapy for psoriasis in SOTRs does not confer an increased risk of skin cancer compared with biologic-naive SOTR controls, specifically with TNF-α inhibitors, supporting their clinical use in this population. Study limitations include small patients counts, which prohibited evaluation of IL-17 or IL-23 inhibitor monotherapy. Nonetheless, our analysis suggests SOTRs receiving biologics for psoriasis do not have an increased cutaneous neoplasm risk compared with SOTRs without exposure to biologics for psoriasis.