Risk of Cutaneous T Cell Lymphoma with Psoriasis Biologic Therapies

Mitchell S Davis; Riley K Spencer; Chandler E Johnson; Kareem G Elhage; Joy Q Jin; Marwa Hakimi; Tina Bhutani; Wilson Liao

doi:10.1007/s13555-023-01074-z

Risk of Cutaneous T Cell Lymphoma with Psoriasis Biologic Therapies

Dermatol Ther (Heidelb). 2024 Jan;14(1):15-30. doi: 10.1007/s13555-023-01074-z. Epub 2023 Dec 3.

Authors

Mitchell S Davis¹, Riley K Spencer^{1

2}, Chandler E Johnson^{1

3}, Kareem G Elhage¹, Joy Q Jin^{1

4}, Marwa Hakimi¹, Tina Bhutani¹, Wilson Liao⁵

Affiliations

¹ Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA.
² Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA.
³ Medical College of Georgia, Augusta, GA, USA.
⁴ School of Medicine, University of California San Francisco, San Francisco, CA, USA.
⁵ Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA. Wilson.liao@ucsf.edu.

Abstract

Background: The risk of developing cutaneous T cell lymphoma (CTCL) in patients using psoriasis biologics has not been well characterized. The goals of this review were to investigate the incidence of CTCL in patients with psoriasis receiving biologic therapy in clinical trials and psoriasis registries, and to review cases of CTCL and biologic use reported in scientific publications.

Methods: The US National Library of Medicine clinical trials database (clinicaltrials.gov) was queried to identify phase 3 and 4 clinical trials of the 12 biologic agents currently FDA approved for psoriatic disease. The incidence of CTCL in these trials was examined and summarized. To examine the incidence of CTCL in psoriasis registries, a Medline search was conducted. Finally, we performed a systematic review of CTCL cases reported in the literature.

Results: Only two cases of CTCL were reported in 35,801 subjects with psoriasis receiving a biologic agent in the active arm of 108 psoriasis phase 3 clinical trials. One of these CTCL cases was determined by the investigator to be CTCL misdiagnosed as psoriasis prior to randomization. No cases of CTCL were reported in 5440 subjects with psoriasis in 34 phase 4 clinical trials. Only one case of CTCL was identified in 34,111 registry subjects. In the literature, tumor necrosis factor (TNF) inhibitors had the highest number of reported cases of CTCL (34 cases), followed by interleukin (IL)-17 inhibitors (7 cases), and IL-12/23 inhibitors (6 cases). No cases of CTCL were found to be reported with IL-23 inhibitors.

Conclusion: Our findings indicate that the development of CTCL is rare in the setting of psoriasis biologic use. Of the limited number of cases of CTCL found, most were in the setting of TNF inhibitor use and no cases of CTCL were reported in the setting of IL-23 inhibitor use.

Keywords: Biologic; CTCL; Cutaneous T cell lymphoma; Interleukin-12/23 inhibitor; Interleukin-17 inhibitor; Interleukin-23 inhibitor; Malignancy; Mycosis fungoides; Psoriasis; TNF inhibitor.

Publication types

Review