Abstract Background There are concerns that biologic therapies for psoriasis may increase cancer risk. Objectives To compare risks of (i) incident cancer excluding keratinocyte carcinomas (KC; hereafter referred to as cancer) and (ii) KC among patients with moderate‐to‐severe psoriasis treated with biologic versus non‐biologic systemic therapies, and across biologic classes. Methods Data from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR), a UK and Republic of Ireland register collected 2007–2025, were linked to NHS Digital for enhanced cancer ascertainment. Biologic‐naïve patients aged ≥16 years with chronic plaque psoriasis and no prior cancer or KC were included. Cancer or KC events occurring within 12 months of treatment initiation were excluded. Crude incidence rates per 1000 person‐years (py) with 95% confidence intervals (CI) were calculated. Adjusted hazard ratios (aHRs; 95% CI) were estimated using propensity score‐weighted flexible parametric survival models with multiple imputation for missing data. Results The cancer and KC analyses included 18,894 and 19,144 patients, respectively (58% receiving biologics in both), reflecting differences in outcome‐specific exclusion criteria. In 1‐year lagged analyses, cancer incidence rates per 1000 person‐years were 6.40 [95% CI 5.83–7.02] in biologic initiators and 6.83 [95% CI 6.01–7.76] in non‐biologic systemic initiators, with an aHR of 0.91 [95% CI 0.77–1.07]. Corresponding KC incidence rates were 2.63 [95% CI 2.28–3.04] and 2.42 [95% CI 1.96–3.00], respectively, with an aHR of 1.05 [95% CI 0.81–1.35]. Follow‐up was shorter for IL‐12/23i and IL‐17i than for TNFi. Cancer risk did not differ significantly for IL‐12/23i or IL‐17i versus TNFi, nor was KC risk elevated for IL‐12/23i. Conclusions This real‐world study found no evidence of an increased risk of cancer or KC with biologic compared with non‐biologic systemic therapies, or across the biologic classes. Larger studies with longer follow‐up, particularly for newer biologics, are needed to clarify long‐term risk.
Abstract Background Bullous pemphigoid (BP) is the most common autoimmune blistering disease and primarily affects older adults. As societies age and the burden of age‐related diseases increases, data on BP epidemiology, treatment patterns and healthcare burden in Germany remain limited. Objectives To assess BP epidemiology, clinical outcomes, healthcare utilization and economic burden in adults aged ≥ 18 years in Germany. Methods We analysed anonymized statutory health insurance claims from 6.8 million insured individuals (2010–2023). Annual cross‐sectional analyses estimated prevalence and incidence, extrapolated to the national population. In a matched incident cohort (BP, n = 2004; controls, n = 9950), we evaluated comorbidity, mortality, healthcare resource utilization, healthcare costs and pharmacologic management over up to 2 years. Mortality and costs were analysed using regression models adjusted for age, sex, calendar year, and comorbidity. Results BP prevalence tripled from 0.05 to 0.14 cases per 1000 individuals between 2010 and 2023, with the steepest increase observed among individuals aged ≥ 80 years. Annual incidence ranged from 34 to 63 cases per million inhabitants. BP patients exhibited a higher comorbidity burden than matched controls (mean Elixhauser index 5.0 vs. 3.8) and increased mortality (1‐year mortality: 18.8% vs. 6.0%; adjusted incidence rate ratio (IRR) 3.09, 95% CI: 2.71–3.52). Healthcare utilization was higher among BP patients, including physician contacts (38 vs. 22 per year) and hospital admissions (3.3 vs. 0.7 per year). Topical and systemic corticosteroids were prescribed in 75% and 72% of patients, respectively; additional therapies included doxycycline (19.7%), dapsone (15.0%) and azathioprine (14.8%). Mean total healthcare costs during the first year were €20,881 for BP patients versus €5586 for controls, mainly attributable to inpatient care. Conclusions BP represents a growing healthcare challenge characterized by a high comorbidity burden, increased mortality and healthcare costs. Current treatment remains reliant on systemic corticosteroids, underscoring the need for safe and effective steroid‐sparing therapies.
