Journal article
The relationship between cancer and medication exposures in systemic lupus erythaematosus: a case–cohort study
Annals of the rheumatic diseases, v 67(1), pp 74-79
Jan 2008
PMID: 17545189
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objective: To examine if, in systemic lupus erythaematosus (SLE), exposure to immunosuppressive therapy (cyclophosphamide, azathioprine, methotrexate) increases cancer risk. Methods: A case–cohort study was performed within a multi-site international SLE cohort; subjects were linked to regional tumour registries to determine cancer cases occurring after entry into the cohort. We calculated the hazard ratio (HR) for cancer after exposure to an immunosuppressive drug, in models that controlled for other medications (anti-malarial drugs, systemic glucocorticoids, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin), smoking, age, sex, race/ethnicity, geographic location, calendar year, SLE duration, and lupus damage scores. In the primary analyses, exposures were treated categorically (ever/never) and as time-dependent. Results: Results are presented from 246 cancer cases and 538 controls without cancer. The adjusted HR for overall cancer risk after any immunosuppressive drug was 0.82 (95% CI 0.50–1.36). Age ⩾65, and the presence of non-malignancy damage were associated with overall cancer risk. For lung cancer (n = 35 cases), smoking was also a prominent risk factor. When looking at haematological cancers specifically (n = 46 cases), there was a suggestion of an increased risk after immunosuppressive drug exposures, particularly when these were lagged by a period of 5 years (adjusted HR 2.29, 95% CI 1.02–5.15). Conclusions: In our SLE sample, age ⩾65, damage, and tobacco exposure were associated with cancer risk. Though immunosuppressive therapy may not be the principal driving factor for overall cancer risk, it may contribute to an increased risk of haematological malignancies. Future studies are in progress to evaluate independent influence of medication exposures and disease activity on risk of malignancy.
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Details
- Title
- The relationship between cancer and medication exposures in systemic lupus erythaematosus: a case–cohort study
- Creators
- S Bernatsky - McGill University Health CentreL Joseph - McGill UniversityJ-F Boivin - McGill UniversityC Gordon - University of TorontoM Urowitz - SUNY Downstate Health Sciences UniversityD Gladman - SUNY Downstate Health Sciences UniversityP R Fortin - SUNY Downstate Health Sciences UniversityE Ginzler - Hanyang UniversityS-C Bae - University of CalgaryS Barr - UCL AustraliaS Edworthy - UCL AustraliaD Isenberg - Johns Hopkins UniversityA Rahman - Johns Hopkins UniversityM Petri - University of AlabamaG S Alarcón - Columbia UniversityC Aranow - University of North Carolina at Chapel HillM-A Dooley - McGill UniversityR Rajan - Université de MontréalJ-L Sénécal - Université de MontréalM Zummer - University of PittsburghS Manzi - Northwestern UniversityR Ramsey-Goldman - Center for RheumatologyA E Clarke - McGill University
- Publication Details
- Annals of the rheumatic diseases, v 67(1), pp 74-79
- Publisher
- British Medical Journal (BMJ)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000251615600014
- Scopus ID
- 2-s2.0-37749038302
- Other Identifier
- 991021934013304721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Rheumatology