Risk of Skin Cancer in Solid Organ Transplant Recipients Prescribed Biologics for Psoriasis: A Nationwide Retrospective Cohort Study Using TriNetX (Preprint)

BACKGROUND Chronic immunosuppressive therapy used in solid organ transplantation and tumor necrosis factor-alpha (TNF-α) inhibitors used for psoriasis treatment are independently associated with an increased risk of cutaneous neoplasms. However, SOTRs are frequently excluded from clinical trials evaluating adverse outcomes of biologic treatment in this vulnerable group with co-existing inflammatory conditions like psoriasis. OBJECTIVE To address this gap, we investigated if biologic therapies increase the risk of skin cancer in SOTRs with psoriasis. METHODS We used TriNetX to access deidentified charts of 4,657 SOTRs with psoriasis between 2015 and 2025 in the United States. Cohorts were propensity score matched for demographics and skin cancer risk factors, resulting in a matched cohort of 414 patients. We calculated the risk for skin cancer diagnosis within ten years following treatment with approved biologics for psoriasis compared with a matched biologic-naive control cohort. Relative risk and 95% confidence intervals were calculated according to the analytics package within TriNetX. RESULTS We identified 456 SOTRs who received TNF-α inhibitors (n=237), IL-17 inhibitors (n=125), IL-23 inhibitors (n=142), and IL-12/23 inhibitors (n=71). The risk for first-time skin cancer diagnosis in patients who received any biologic did not differ significantly from the biologic-naive cohort (Any Skin Cancer: p=0.222, Melanoma: p=0.656; NMSC: p=0.178). A similar insignificant skin cancer risk was seen in patients receiving TNF-α inhibitor monotherapy (Any Skin Cancer: p=0.240, Melanoma: p=1.000; NMSC: p=0.230). CONCLUSIONS The findings of this cohort study suggest biologic therapy for psoriasis in SOTRs does not confer an increased risk of skin cancer compared with biologic-naïve SOTR controls, specifically with TNF-α inhibitors, supporting their clinical use in this population. Study limitations include small patients counts, which prohibited evaluation of IL-17 or IL-23 inhibitor monotherapy. Nonetheless, our analysis suggests SOTRs receiving biologics for psoriasis do not have an increased cutaneous neoplasm risk compared to SOTRs without exposure to biologics for psoriasis.