P072 Risk of incident cancer, excluding keratinocyte carcinoma, in patients with psoriasis treated with biologic therapy: a prospective cohort study from the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR), on behalf of the BADBIR Study Group
Authors: Esse Shamarke , Alabas Oras , Mason Kayleigh , Ryan Sarah , Reynolds Nick J , Smith Catherine , Green Adele , Warren Richard B 
Published: June 2024

Abstract
There are long-standing concerns that the use of biologic therapies to treat patients with psoriasis could confer an increased risk of developing cancer due to their immunomodulatory effects. We aimed to assess the risk of any incident cancer (excluding keratinocyte carcinoma, KC), hereafter termed ‘incident cancer’, in patients with moderate-to-­severe psoriasis treated with biologic therapy compared with nonbiologic systemic therapy. We used data from BADBIR, a multicentre register evaluating the long-term safety and effectiveness of systemic therapy for patients with moderate-to-severe psoriasis, between September 2007 and November 2023, with linkage to data from NHS Digital to ascertain incident cancers not captured in BADBIR. Eligible for inclusion were patients with chronic plaque psoriasis, who were biologic naive at registration to BADBIR, who had no personal history of cancer (excluding KC) and who had completed at least one follow-up visit. To balance between the compared groups in their baseline characteristics, we calculated probability-weighted regression adjustment estimators with a propensity score model including age, sex, body mass index, smoking, alcohol consumption, previous exposure to nonbiologic systemic therapy and number of comorbidities. Therefore, these weights were used in a flexible parametric survival model to estimate hazard ratios for developing incident cancers, using imputed data. There were 11 185 patients (66%) registered to the biologic cohort and 5673 patients (34%) to the nonbiologic systemic cohort. The biologic cohort was older (median age 44 years, interquartile range 34–54 vs. 42 years, interquartile range 32–53), with more men (59% vs. 57%) and comorbidities (68% vs. 61%) compared with the nonbiologic systemic cohort. Patients in the biologic cohort contributed 73 643 person-years of follow-up and patients in the nonbiologic systemic cohort contributed 23 694 person-years. During follow-up, 467 patients (4%) in the biologic cohort and 169 patients (3%) in the nonbiologic systemic cohort developed incident cancer. There was no significant difference in the risk of developing incident cancer between the biologic cohort and the nonbiologic systemic cohort (adjusted hazard ratio 0.88, 95% confidence interval 0.69–1.11). The results from these real-world data are reassuring for patients with psoriasis and clinicians, as it appears that treatment with biologic therapy does not confer an increased risk of developing overall cancer (excluding KC), in the short-to-medium term, compared with nonbiologic systemic therapy. However, given the heterogeneity of all cancers combined, risks of developing cancers from common subgroups or site-specific cancers (breast, prostate, lung, colorectal and melanoma) in biologic-treated patients need to be investigated. This study is funded by the Psoriasis Association.