Do Biologic Therapies Increase the Risk for Melanoma?

While biologic therapies were positively associated with an increased risk for developing melanoma compared with conventional systemic therapies, this association was not statistically significant, according to a recent study. However, the authors noted more large, well-designed studies are needed to improve the certainty of this finding.

Biologic agents are widely prescribed to treat immune-mediated inflammatory diseases, such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and psoriasis. There are concerns that compared with treatment with conventional systemic therapy, biologic therapies may be associated with an increased risk of melanoma, the authors said.
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They conducted a systematic review and meta-analysis of randomized clinical trials, cohort studies, and nested case-control studies to assess the risk of melanoma among patients treated with biologic therapies compared with conventional systemic therapies. The review included 7 cohort studies, with a total of 34,029 biologic-treated patients and 135,370 biologic-naïve patients treated with conventional systemic therapy.

Biologic treatment was positively associated with melanoma compared with conventional systemic therapies, according to the researchers; however, the differences were not statistically significant. The pooled relative risk (pRR) of melanoma among patients with IBD and those with RA were 1.20 (95% CI, 0.60-2.40) and 1.20 (0.83-1.74), respectively, and the hazard ratio of melanoma among patients with psoriasis was 1.57 (95% CI, 0.61-4.09). In addition, the researchers noted that adjustment for other risk factors were absent from most studies.

“The findings suggest that clinically important increases in melanoma risk in patients treated with biologic therapy for common inflammatory diseases cannot be ruled out based on current evidence,” the researchers concluded. “However, further studies with large patient numbers that adjust for key risk factors are needed to resolve the issue of long-term safety of biologic therapy.”

Reference
Esse S, Mason KJ, Green AC, Warren RB. Melanoma risk in patients treated with biologic therapy for common inflammatory diseases: A systematic review and meta-analysis [published online May 20, 2020]. JAMA Dermatol. doi:10.1001/jamadermatol.2020.1300