TY - JOUR
T1 - Use of immunosuppression and subsequent cancer incidence
T2 - cohort study
AU - Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study Research Group
AU - Buchanich, Jeanine M.
AU - Newcomb, Craig W.
AU - Washington, Terri L.
AU - Foster, Charles Stephen
AU - Sobrin, Lucia
AU - Thorne, Jennifer E.
AU - Jabs, Douglas Alan
AU - Suhler, Eric B.
AU - Rosenbaum, James T.
AU - Sen, Hatice Nida
AU - Levy-Clarke, Grace A.
AU - Nussenblatt, Robert B.
AU - Bhatt, Nirali P.
AU - Lowder, Careen Y.
AU - Goldstein, Debra A.
AU - Leiderman, Yannek I.
AU - Acharya, Nisha R.
AU - Holland, Gary N.
AU - Read, Russell W.
AU - Dunn, James P.
AU - Dreger, Kurt A.
AU - Artornsombudh, Pichaporn
AU - Begum, Hosne A.
AU - Fitzgerald, Tonetta D.
AU - Kothari, Srishti
AU - Payal, Abhishek R.
AU - Daniel, Ebenezer
AU - Gangaputra, Sapna S.
AU - Kaçmaz, Roje Oktay
AU - Liesegang, Teresa L.
AU - Pujari, Siddharth S.
AU - Khachatryan, Naira
AU - Maghsoudlou, Armin
AU - Suga, Hilkiah K.
AU - Pak, Clara M.
AU - Helzlsouer, Kathy J.
AU - Kempen, John H.
AU - Suga, Hilkiah K.
AU - Pak, Clara
AU - Sobrin, Lucia
AU - Caccaviello, John
AU - Stephen Foster, C.
AU - Oktay Kacmaz, R.
AU - Pujari, Siddharth S.
AU - Artornsombudh, Pichaporn
AU - Kothari, Srishti
AU - Khachatryan, Naira
AU - Maghsoudlou, Armin
AU - Jabs, Douglas A.
AU - Latkany, Paul A.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/8/21
Y1 - 2023/8/21
N2 - Objective Evaluate the association between cancer incidence and immunosuppressive treatment in patients with ocular inflammatory disease (OID). Methods and analysis We performed a retrospective cohort study of patients from 10 US OID subspecialty practices. Patients with non-infectious OID were included; HIV-infected patients were excluded. Time-dependent exposure to drug classes (ie, antimetabolites, calcineurin inhibitors, alkylating agents, tumour necrosis factor (TNF) inhibitors) and drugs were evaluated. Cancer incidence was ascertained by linkage to 12 state cancer registries from 1996 to 2015. Cancer incidence was analysed using Cox regression survival analysis, using 0-year, 3-year and 5-year lags after immunosuppression began. Results The cancer incidence cohort comprised 10 872 individuals at risk of incident cancer and residing in one of the 12 states covered; 812 primary cancers were identified through cancer incidence tracing with median follow-up time of 10 years. Neither TNF inhibitor, antimetabolite, calcineurin inhibitor nor alkylating agent classes were associated with statistically significant increases in cancer incidence adjusting for covariates. We found statistically significant reduced hazards in the systemic inflammatory disease (SID)-including cohort for adalimumab and chlorambucil, increased hazards for tacrolimus and etanercept in the non-SID cohort and reduced hazards for methotrexate in both. Other immunosuppressive drugs were not associated with overall cancer incidence. Conclusions We found no increased risk of overall or site-specific cancer incidence associated with short-term (non-transplant) therapy with most commonly used immunosuppressive drug classes and many specific drugs. Further research may clarify potentially protective or harmful effects of specific agents that were not consistently associated with reduced or increased cancer incidence. Trial registration number NCT00116090.
AB - Objective Evaluate the association between cancer incidence and immunosuppressive treatment in patients with ocular inflammatory disease (OID). Methods and analysis We performed a retrospective cohort study of patients from 10 US OID subspecialty practices. Patients with non-infectious OID were included; HIV-infected patients were excluded. Time-dependent exposure to drug classes (ie, antimetabolites, calcineurin inhibitors, alkylating agents, tumour necrosis factor (TNF) inhibitors) and drugs were evaluated. Cancer incidence was ascertained by linkage to 12 state cancer registries from 1996 to 2015. Cancer incidence was analysed using Cox regression survival analysis, using 0-year, 3-year and 5-year lags after immunosuppression began. Results The cancer incidence cohort comprised 10 872 individuals at risk of incident cancer and residing in one of the 12 states covered; 812 primary cancers were identified through cancer incidence tracing with median follow-up time of 10 years. Neither TNF inhibitor, antimetabolite, calcineurin inhibitor nor alkylating agent classes were associated with statistically significant increases in cancer incidence adjusting for covariates. We found statistically significant reduced hazards in the systemic inflammatory disease (SID)-including cohort for adalimumab and chlorambucil, increased hazards for tacrolimus and etanercept in the non-SID cohort and reduced hazards for methotrexate in both. Other immunosuppressive drugs were not associated with overall cancer incidence. Conclusions We found no increased risk of overall or site-specific cancer incidence associated with short-term (non-transplant) therapy with most commonly used immunosuppressive drug classes and many specific drugs. Further research may clarify potentially protective or harmful effects of specific agents that were not consistently associated with reduced or increased cancer incidence. Trial registration number NCT00116090.
KW - epidemiology
KW - immunomodulation
UR - http://www.scopus.com/inward/record.url?scp=85187417129&partnerID=8YFLogxK
U2 - 10.1136/bmjonc-2023-000037
DO - 10.1136/bmjonc-2023-000037
M3 - Article
AN - SCOPUS:85187417129
SN - 2752-7948
VL - 2
JO - BMJ Oncology
JF - BMJ Oncology
IS - 1
M1 - e000037
ER -