BMJ Oncology (Aug 2023)
Use of immunosuppression and subsequent cancer incidence: cohort study
- Naira Khachatryan,
- Gui-Shuang Ying,
- James T Rosenbaum,
- Gary N Holland,
- Maxwell Pistilli,
- John H. Kempen,
- Nisha R Acharya,
- Debra A Goldstein,
- John H Kempen,
- Ebenezer Daniel,
- Jennifer E Thorne,
- Careen Y Lowder,
- Teresa L Liesegang,
- Eric B Suhler,
- Grace A Levy-Clarke,
- Robert B Nussenblatt,
- Tracy Giles,
- RUSSELL W READ,
- Yannek I Leiderman,
- Craig W Newcomb,
- Nirali P Bhatt,
- James P Dunn,
- Asaf Hanish,
- Kathy J Helzlsouer,
- Siddharth S Pujari,
- Teresa Liesegang,
- Lucia Sobrin,
- Hosne Begum,
- Pichaporn Artornsombudh,
- Jeanine M Buchanich,
- Terri L Washington,
- Charles Stephen Foster,
- Douglas Alan Jabs,
- Hatice Nida Sen,
- Kurt A Dreger,
- Hosne A Begum,
- Tonetta D Fitzgerald,
- Srishti Kothari,
- Abhishek R Payal,
- Sapna S Gangaputra,
- Roje Oktay Kaçmaz,
- Armin Maghsoudlou,
- Hilkiah K Suga,
- Clara M Pak,
- Hilkiah K. Suga,
- John Caccaviello,
- C. Stephen Foster,
- R. Oktay Kaçmaz,
- Siddharth S. Pujari,
- Abhishek Payal,
- Jennifer E. Thorne,
- Douglas A. Jabs,
- Kurt A. Dreger,
- James P. Dunn,
- Sapna S. Gangaputra,
- Eric B. Suhler,
- James T. Rosenbaum,
- H. Nida Sen,
- Grace A. Levy-Clarke,
- Robert B. Nussenblatt,
- Nirali P. Bhatt,
- Tonetta D. Fitzgerald,
- Kathy J. Helzlsouer,
- Marshall M. Joffe,
- Jeanine M. Buchanich,
- Terri L. Washington,
- Careen Y. Lowder,
- Gary N. Holland,
- Nisha R. Acharya,
- Yannek I. Liederman,
- Jie Debra A. Goldstein,
- Debra A. Goldstein,
- Jie (Jessica) Sun,
- Russell W. Read,
- Glenn J. Jaffe,
- Paul A. Latkany,
- Janet L. Davis,
- Sunir J. Garg
Affiliations
- Naira Khachatryan
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Gui-Shuang Ying
- 5 Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- James T Rosenbaum
- 3 Department of Ophthalmology, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
- Gary N Holland
- Ocular Inflammatory Disease Center, Jules Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, Los Angeles, California, USA
- Maxwell Pistilli
- John H. Kempen
- Nisha R Acharya
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Debra A Goldstein
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- John H Kempen
- 10 Sight for Souls, Fort Myers, Florida, USA
- Ebenezer Daniel
- 5 Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Jennifer E Thorne
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Careen Y Lowder
- Cole Eye Institute, Department of Ophthalmology, Cleveland Clinic, Cleveland, Ohio, USA
- Teresa L Liesegang
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
- Eric B Suhler
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
- Grace A Levy-Clarke
- Department of Ophthalmology and Visual Sciences, West Virginia University School of Medicine, Morgantown, West Virginia, USA
- Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland, USA
- Tracy Giles
- RUSSELL W READ
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
- Yannek I Leiderman
- Illinois Eye & Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois Chicago College of Medicine, Chicago, Illinois, USA
- Craig W Newcomb
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Nirali P Bhatt
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- James P Dunn
- Mid-Atlantic Retina, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Asaf Hanish
- Kathy J Helzlsouer
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Siddharth S Pujari
- Siddharth Netralaya Superspecialty Eye Hospital, Belgaum, Karnataka, India
- Teresa Liesegang
- Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Hosne Begum
- 6 Wilmer Eye Institute, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
- Pichaporn Artornsombudh
- 7 Ophthalmology, Somdech Phra Pinklao Hospital, Bangkok, Thailand
- Jeanine M Buchanich
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Terri L Washington
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Charles Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Boston, Massachusetts, USA
- Douglas Alan Jabs
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Hatice Nida Sen
- Department of Ophthalmology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Kurt A Dreger
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, Maryland, USA
- Hosne A Begum
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Tonetta D Fitzgerald
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Srishti Kothari
- Department of Ophthalmology and Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
- Abhishek R Payal
- Mahatme EyeBank Eye Hospital, Nagpur, Maharashtra, India
- Sapna S Gangaputra
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Roje Oktay Kaçmaz
- Santen Pharmaceutical Co Ltd, Emeryville, California, USA
- Armin Maghsoudlou
- Neurology, Northwell Health, Staten Island, New York, USA
- Hilkiah K Suga
- MyungSung Medical College, Addis Ababa, Addis Ababa, Ethiopia
- Clara M Pak
- MCM Eye Unit, MyungSung Christian Medical Center (MCM) General Hospital and MyungSung Medical School, Addis Ababa, Addis Ababa, Ethiopia
- Hilkiah K. Suga
- John Caccaviello
- C. Stephen Foster
- R. Oktay Kaçmaz
- Siddharth S. Pujari
- Abhishek Payal
- Jennifer E. Thorne
- Douglas A. Jabs
- Kurt A. Dreger
- James P. Dunn
- Sapna S. Gangaputra
- Eric B. Suhler
- James T. Rosenbaum
- H. Nida Sen
- Grace A. Levy-Clarke
- Robert B. Nussenblatt
- Nirali P. Bhatt
- Tonetta D. Fitzgerald
- Kathy J. Helzlsouer
- Marshall M. Joffe
- Jeanine M. Buchanich
- Terri L. Washington
- Careen Y. Lowder
- Gary N. Holland
- Nisha R. Acharya
- Yannek I. Liederman
- Jie Debra A. Goldstein
- Debra A. Goldstein
- Jie (Jessica) Sun
- Russell W. Read
- Glenn J. Jaffe
- Paul A. Latkany
- Janet L. Davis
- Sunir J. Garg
- DOI
- https://doi.org/10.1136/bmjonc-2023-000037
- Journal volume & issue
-
Vol. 2,
no. 1
Abstract
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.
