Psoriasis vulgaris in patients with a recent history of neoplasia: safety of interleukin-23 inhibitors. A multicentre retrospective study

Background The management of psoriasis in patients with a history of cancer remains debated, especially for the limited literature available. Given the lack of large, well-designed studies focused on this patient group, real-world clinical experiences and expert insights serve as crucial resources for guiding informed treatment decisions. This issue particularly regards the newest anti-interleukin (IL) drugs available, such as those targeting IL-23. Objectives To analyse a real-world population of patients with psoriasis undergoing biologic treatment with anti-IL-23 drugs who also have a concurrent cancer diagnosis. Methods A retrospective, observational, multicentre study was conducted, enrolling adult patients with moderate-to-severe plaque psoriasis and a personal history of malignancy. The patients were undergoing any anti-IL-23 treatment approved for psoriasis (guselkumab, risankizumab or tildrakizumab). Results In total, 198 patients were enrolled. Among these, 67 (33.8%) had a history of malignancy within the past 5 years, whereas 131 (66.2%) had been diagnosed with cancer prior to that time. During the period of the study, six patients (3.0%) experienced progression or recurrence of their existing neoplasia. Moreover, six (3.0%) were diagnosed with a new neoplasia during the study period, discontinuing biologic treatment in only two cases. A subanalysis investigating the relationship between comorbidities and the incidence of neoplastic progression or recurrence during therapy, as well as the development of a new neoplasia, did not show any statistically significant associations. Similarly, significant associations between previous treatments and increased risk of cancer recurrence, progression or development were not found. Conclusions Our real-life experience is the largest study investigating the use of anti-IL-23 agents and the risk of cancer recurrence, progression and development in patients with a history of cancer. This study confirms their safety also in this cohort of patients.