An evidence-based review of skin cancer rates on biologic therapies.
ABSTRACT To critically review the body of clinical trials that report the rates of skin cancer in patients on a biologic therapy, in order to discern whether this therapy is associated with any increase risk of skin cancer.
Review of MEDLINE database and the Cochrane library database was conducted, to identify randomized controlled trials and meta-analyses that evaluated the safety of biologic therapies, and specifically reported rates of skin cancer in patients on biologic therapies.
Two reviewers independently evaluated eligibility and collected the data. Studies selected were large randomized controlled trials and meta-analyses with large number of patient populations from clinical trials and post-marketing surveillance data that reported specifically the rate of skin cancer while on a biologic therapy.
Nine studies met the eligibility criteria. All studies were of high quality with Strength of Recommendation Taxonomy (SORT) (J Am Board Fam Pract 2004) evidence level of 1. Eight of these trials demonstrated an increased risk of non-melanoma skin cancer (NMSC) while on a biologic therapy. In addition, studies suggested a possible increased risk in patients with history of prior treatments known to also increase risk of skin cancer. Case studies with SORT evidence level 3 are also included in this review for completion; however, these data were not used in the formation of final recommendations.
Biologic medications are highly efficacious and have a relatively good safety profile; however, high-quality evidence suggests that use of biologic therapies may be associated with an increased risk of detection of NMSC. Psoriatic patients may be at an increased risk due to history of treatment with other therapies also known to increase the risk of skin cancer. As such, it may be important to consider biologic therapies as an additional risk factor for development of NMSC and implement regular skin examinations for patients on these therapies.
SourceAvailable from: Xiaoyan Angela Qu[Show abstract] [Hide abstract]
ABSTRACT: Psoriasis is a chronic inflammatory skin disease with complex pathological features and unmet pharmacotherapy needs. Here, we present a framework for developing new therapeutic intervention strategies for psoriasis by utilizing publicly available clinical transcriptomics data sets. By exploring the underlying molecular mechanisms of psoriasis, the effects of subsequent perturbation of these mechanisms by drugs and an integrative analysis, we propose a psoriasis disease signature, identify potential drug repurposing opportunities and present novel target selection methodologies. We anticipate that the outlined methodology or similar approaches will further support biomarker discovery and the development of new drugs for psoriasis.Drug discovery today 09/2014; 19(9). DOI:10.1016/j.drudis.2014.03.015 · 5.96 Impact Factor
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ABSTRACT: The treatment of psoriasis has evolved over the years, with the focus now largely on the use of biologic agents. With treatment options expanding, evidence-based studies to guide physicians' treatment decisions become increasingly important. Our objective was to review current literature to provide an evidence-based update on systemic therapies for psoriasis. A systematic review of the literature was conducted from 1 January 2012 through 1 July 2013 to identify all randomized clinical trials and systematic reviews of systemic psoriasis treatments. A total of 46 publications were identified and reviewed. Randomized clinical trials for the treatment of psoriasis focused heavily on biologic agents, both currently approved agents and anti-interleukin (IL)-17 agents in development. The anti-IL-17 agents appear effective according to phase II clinical trials. Several new oral agents are being studied, and, although they do not appear as effective as the biologic agents, they may be an option as an alternative to traditional oral agents, with more favorable safety profiles. Several systematic reviews focused on efficacy among the biologics, with infliximab consistently superior to the others, and etanercept the least effective of the tumor necrosis factor-alpha inhibitors. Longer-term safety data on biologics is now available and encouraging. Current studies of traditional oral therapies are lacking. Current studies continue to support the use of biologic agents in the treatment of moderate to severe psoriasis, with better efficacy and safety profiles than traditional systemic agents. Newer anti-IL-17 agents and several new oral agents are in development and have shown promise in clinical trials.American Journal of Clinical Dermatology 02/2014; DOI:10.1007/s40257-014-0064-x · 2.52 Impact Factor
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ABSTRACT: Background Etanercept is a tumour necrosis factor-alpha antagonist used for the treatment of moderate-to-severe psoriasis. Current opinion suggests that etanercept may have reduced efficacy in obese patients. Narrowband ultraviolet B (NB-UVB) phototherapy is unaffected by body weight and the addition of NB-UVB to etanercept therapy may supplement the efficacy of etanercept in these patients. Objective To evaluate the efficacy and safety of NB-UVB phototherapy when administered in conjunction with 50 mg of etanercept once weekly in the treatment of obese patients with moderate-to-severe plaque psoriasis. Methods Thirty psoriasis patients with a body mass index (BMI) greater than 30 were enrolled into this randomized, 'head-to-head' comparison study. All subjects received 50 mg of etanercept twice weekly for 12 weeks and then randomized to receive either etanercept monotherapy or combination etanercept and NB-UVB three times weekly for an additional 12 weeks. Treatment response was evaluated using Psoriasis Area and Severity Index (PASI), body surface area (BSA) and Physician's Global Assessment (PGA) scores. Results Twenty-five subjects completed the study. At 12 weeks, 48% of all patients achieved PASI 75. By Week 24, 62.5% of all patients achieved PASI 75. Patients in the etanercept monotherapy and combination etanercept and NB-UVB phototherapy arms had similar rates of achieving PASI 75 (46.7% vs. 53.3% of each group, respectively). Conclusion Combination etanercept and NB-UVB has similar efficacy to etanercept monotherapy in obese patients. This result indicates that even in the setting of obesity, the majority of patients respond well to etanercept, with or without NB-UVB.Journal of the European Academy of Dermatology and Venereology 06/2012; 27(7). DOI:10.1111/j.1468-3083.2012.04611.x · 3.11 Impact Factor