The risk of melanoma in patients with immune-mediated inflammatory diseases exposed to biological therapies: systematic review and meta-analysis

Esse, S.; Mason, K. J.; Green, A. C.; Warren, R. B.

Abstract

Biological therapies are used in the treatment of immunemediated inflammatory diseases (IMIDs), including moderateto-severe psoriasis, rheumatoid arthritis (RA), psoriatic arthritis
(PsA) and inflammatory bowel disease (IBD). Melanoma is a
highly immunogenic and potentially aggressive form of skin
cancer with an increasing global incidence over the past three
decades. There are concerns that biologics could increase the risk
of melanoma due to their immunosuppressive mechanisms. The
aim of this study was to conduct a systematic review and metaanalysis of studies investigating the risk of melanoma in biologic-exposed patients with psoriasis, RA, PsA and IBD compared with biologic-naive patients with the same disease and/or
the general population. A literature search was conducted using
MEDLINE, Embase and the Cochrane Library. Randomized controlled trials, cohort studies and nested case–control studies were
included if the risk of melanoma was investigated in biologicexposed patients with psoriasis, RA, PsA or IBD who were followed up for at least 1 year. Comparator cohorts included biologic-naive patients with the same IMID and/or the general
population. In total, 12 058 records were identified through
database searching, of which 799 underwent abstract screening.
Sixteen eligible studies comprising 86 454 biologic-exposed
patients, 151 507 biologic-naive patients and 181 501 controls
from general populations were identified and included in the
systematic review and meta-analysis. An increased risk of melanoma was observed for biologic-exposed patients with IBD
[three studies; pooled relative risk (pRR) 1.58, 95% confidence
interval (CI) 1.02–2.43], but not for psoriasis (one study; pRR
1.57, 95% CI 0.61–4.07), PsA (one study; pRR 1.70, 95% CI
0.69–4.16) or RA (four studies; pRR 1.27, 95% CI 0.84–1.90)
compared with biologic-naive patients. Conversely, an increased
risk of melanoma was observed for biologic-exposed patients
with RA (nine studies; pRR 1.45, 95% CI 1.13–1.87) but not
psoriasis (two studies; pRR 2.56, 95% CI 0.85–7.68), PsA (one
study; pRR 1.50, 95% CI 0.69–3.26) or IBD (one study; pRR
1.05, 95% CI 0.46–2.38) compared with the general population. The risk of melanoma was significantly increased for biologic-exposed patients with IBD compared with biologic-naive
patients and for biologic-exposed patients with RA compared
with the general population. Due to the small number of disease-specific studies, variability in adjustment for confounders
(particularly cumulative ultraviolet exposure) and limited
patient follow-up, further studies are required to determine
whether biological therapies do increase the risk of melanoma.

Citation

Esse, S., Mason, K. J., Green, A. C., & Warren, R. B. (2019, July). The risk of melanoma in patients with immune-mediated inflammatory diseases exposed to biological therapies: systematic review and meta-analysis. Poster presented at BRITISH ASSOCIATION OF DERMATOLOGISTS 99TH ANNUAL MEETING, LIVERPOOL, U.K

• Presentation Conference Type: Poster
• Conference Name: BRITISH ASSOCIATION OF DERMATOLOGISTS 99TH ANNUAL MEETING
• Conference Location: LIVERPOOL, U.K.
• Start Date: Jul 2, 2019
• End Date: Jul 4, 2019
• Deposit Date: Jun 28, 2023
• Publisher URL: https://academic.oup.com/bjd/article/181/S1/25/6602145