Short-term use of immunosuppressants in patients with ocular inflammatory disease may not be associated with an increased risk of developing cancer, according to a recent study published by Buchanich et al in BMJ Oncology.
Background
The Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort was launched 2 decades ago when researchers began evaluating the cancer risk of patients with noninfectious ocular inflammatory diseases taking immunosuppressants.
These ocular diseases are caused by immune dysfunction, and although they do not cause cancer, they can lead to blindness. As a result, the diseases are commonly treated with immunosuppressive agents for several months or years.
However, immunosuppressive agents have been known to increase the risk of cancer when taken over longer periods of time—which may cause physicians to hesitate in prescribing the agents.
In a previous study, published by Kempen et al in Ophthalmology, the researchers found no increased risk of cancer-related and overall mortality in patients taking commonly used immunosuppressants.
“When we got these results, I was reassured, and I hope patients will be, too,” said lead study author Jeanine Buchanich, PhD, Associate Professor of Biostatistics, Director of the Center for Occupational Biostatistics and Epidemiology, and Associate Dean for Research at the University of Pittsburgh School of Public Health. “Immunosuppressants are widely used and transformative for care [in] patients with inflammatory diseases, but the potential concern that they carry a cancer risk has forced [patients] to make difficult decisions without enough information. Alleviating that concern with use for inflammatory diseases will help [patients] make the treatment decision that’s right for them,” she added.
Study Methods and Results
In the new study, the researchers examined the outcomes of 10,872 patients with ocular inflammatory disease who received or did not receive four classes of immunosuppressants—tumor necrosis factor inhibitors, antimetabolites, alkylating agents, and calcineurin inhibitors—for a median of 1 year.
After a follow-up of 10 years, the researchers discovered that across all four classes, there was no evidence of an excess risk of cancer in patients who took the agents on a short-term basis, regardless of the dosage.
Conclusions
The researchers explained that although most states track cancer incidence, there is no centralized federal cancer registry—and each state requires different permissions and uses different interfaces to share data. For this reason, it may be difficult to do large-scale epidemiologic cancer studies in the United States.
While the researchers cautioned that the results of their study do not include all patients taking immunosuppressants, they may demonstrate the safety of short-term immunosuppressant use among patients with inflammatory diseases.
“The patients in our study actually tended to have a lower incidence of cancer than [patients who were not] immunosuppressed, suggesting that an increased risk of overall cancer from commonly used immunosuppressants given for the short to medium term is very unlikely,” emphasized senior study author John Kempen, MD, MPH PhD, MHS, Professor of Ophthalmology at Harvard Medical School and Director of Epidemiology for Ophthalmology at Massachusetts Eye and Ear at Mass General Brigham. “This result is foundational for a large number of patients with inflammatory [ocular] conditions and a broad range of patients with other inflammatory diseases,” he concluded.
Disclosure: The research in this study was supported by grants from the National Institutes of Health (NIH), the NIH University of Pennsylvania Core Grant for Vision Research, the Massachusetts Eye and Ear Global Surgery Program, Sight for Souls, and Research to Prevent Blindness. For full disclosures of the study authors, visit bmjoncology.bmj.com.
