A Retrospective Database Cohort Study Evaluating the Association Between Immune Suppressive Therapy and the Development of Cancer in Patients with Atopic Dermatitis Within UK Primary Care
Introduction: First-line regular systemic treatment for atopic dermatitis (AD) in the UK consists of methotrexate, azathioprine, ciclosporin, or mycophenolate (immune-suppressive therapies [IST]). ISTs have been associated with malignancy, hence the need for evaluation for the relationship to the r...
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European Medical Journal
2022-05-01
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| Series: | European Medical Journal |
| Online Access: | https://www.emjreviews.com/a-retrospective-database-cohort-study-evaluating-the-association-between-immune-suppressive-therapy-and-the-development-of-cancer-in-patients-with-atopic-dermatitis-within-uk-primary-care/ |
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| author | Simon Wan Yau Ming Yi Zhou Mike Smith Jay Were |
| author_facet | Simon Wan Yau Ming Yi Zhou Mike Smith Jay Were |
| author_sort | Simon Wan Yau Ming |
| collection | DOAJ |
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Introduction: First-line regular systemic treatment for atopic dermatitis (AD) in the UK consists of methotrexate, azathioprine, ciclosporin, or mycophenolate (immune-suppressive therapies [IST]). ISTs have been associated with malignancy, hence the need for evaluation for the relationship to the risk of developing cancer. Method: This retrospective cohort study utilising the Clinical Practice Research Datalink (CPRD) followed two cohorts with moderate or severe AD: one prescribed ISTs and one without. A total of 222,978 patients were included. The index date was the date of first IST prescription within primary care for the IST cohort, and the date of first potent topical steroid prescription from January 2001 to May 2021. Cohorts were propensity matched 1:1, resulting in 17,556 patients per cohort. Cox proportional hazard models were used to model the hazard of a cancer diagnosis. A secondary analysis was carried out on a restricted population, excluding patients with other comorbidities where ISTs were commonly prescribed. A further analysis explored the relation between the dose and the association with the risk of cancer. Results: Both the primary (hazard ratio: 1.01; 95% confidence interval: 0.94–1.08) and secondary (hazard ratio: 1.03; 95% confidence interval: 0.93–1.14) analyses did not show a significant difference in the hazard of a cancer code in the IST and non-IST cohorts. The exploratory dose–response analysis showed a higher risk of cancer associated with more prescriptions of IST per year. Conclusion: This study shows that amongst patients with moderate or severe AD, overall IST prescription in primary care is not associated with the onset of a cancer code. However, there is a trend with a higher risk of cancer coding with more prescriptions of IST. |
| format | Article |
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| institution | Kabale University |
| issn | 2397-6764 |
| language | English |
| publishDate | 2022-05-01 |
| publisher | European Medical Journal |
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| spelling | doaj-art-99a4bfc52cd744dfa6b90e15e965217f2025-01-16T16:56:04ZengEuropean Medical JournalEuropean Medical Journal2397-67642022-05-0110.33590/emj/22-00004A Retrospective Database Cohort Study Evaluating the Association Between Immune Suppressive Therapy and the Development of Cancer in Patients with Atopic Dermatitis Within UK Primary CareSimon Wan Yau Ming0Yi Zhou1Mike Smith2Jay Were3Health iQ, London, UKHealth iQ, London, UKHealth iQ, London, UKHealth iQ, London, UK Introduction: First-line regular systemic treatment for atopic dermatitis (AD) in the UK consists of methotrexate, azathioprine, ciclosporin, or mycophenolate (immune-suppressive therapies [IST]). ISTs have been associated with malignancy, hence the need for evaluation for the relationship to the risk of developing cancer. Method: This retrospective cohort study utilising the Clinical Practice Research Datalink (CPRD) followed two cohorts with moderate or severe AD: one prescribed ISTs and one without. A total of 222,978 patients were included. The index date was the date of first IST prescription within primary care for the IST cohort, and the date of first potent topical steroid prescription from January 2001 to May 2021. Cohorts were propensity matched 1:1, resulting in 17,556 patients per cohort. Cox proportional hazard models were used to model the hazard of a cancer diagnosis. A secondary analysis was carried out on a restricted population, excluding patients with other comorbidities where ISTs were commonly prescribed. A further analysis explored the relation between the dose and the association with the risk of cancer. Results: Both the primary (hazard ratio: 1.01; 95% confidence interval: 0.94–1.08) and secondary (hazard ratio: 1.03; 95% confidence interval: 0.93–1.14) analyses did not show a significant difference in the hazard of a cancer code in the IST and non-IST cohorts. The exploratory dose–response analysis showed a higher risk of cancer associated with more prescriptions of IST per year. Conclusion: This study shows that amongst patients with moderate or severe AD, overall IST prescription in primary care is not associated with the onset of a cancer code. However, there is a trend with a higher risk of cancer coding with more prescriptions of IST.https://www.emjreviews.com/a-retrospective-database-cohort-study-evaluating-the-association-between-immune-suppressive-therapy-and-the-development-of-cancer-in-patients-with-atopic-dermatitis-within-uk-primary-care/ |
| spellingShingle | Simon Wan Yau Ming Yi Zhou Mike Smith Jay Were A Retrospective Database Cohort Study Evaluating the Association Between Immune Suppressive Therapy and the Development of Cancer in Patients with Atopic Dermatitis Within UK Primary Care European Medical Journal |
| title | A Retrospective Database Cohort Study Evaluating the Association Between Immune Suppressive Therapy and the Development of Cancer in Patients with Atopic Dermatitis Within UK Primary Care |
| title_full | A Retrospective Database Cohort Study Evaluating the Association Between Immune Suppressive Therapy and the Development of Cancer in Patients with Atopic Dermatitis Within UK Primary Care |
| title_fullStr | A Retrospective Database Cohort Study Evaluating the Association Between Immune Suppressive Therapy and the Development of Cancer in Patients with Atopic Dermatitis Within UK Primary Care |
| title_full_unstemmed | A Retrospective Database Cohort Study Evaluating the Association Between Immune Suppressive Therapy and the Development of Cancer in Patients with Atopic Dermatitis Within UK Primary Care |
| title_short | A Retrospective Database Cohort Study Evaluating the Association Between Immune Suppressive Therapy and the Development of Cancer in Patients with Atopic Dermatitis Within UK Primary Care |
| title_sort | retrospective database cohort study evaluating the association between immune suppressive therapy and the development of cancer in patients with atopic dermatitis within uk primary care |
| url | https://www.emjreviews.com/a-retrospective-database-cohort-study-evaluating-the-association-between-immune-suppressive-therapy-and-the-development-of-cancer-in-patients-with-atopic-dermatitis-within-uk-primary-care/ |
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