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.
Link:
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
.
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