The dietary supplement nicotinamide has been recommended by dermatologists for people with a history of skin cancer since 2015, when a clinical study published by Chen et al in The New England Journal of Medicine including almost 400 participants showed that those who took the vitamin B3 derivative orally developed fewer new occurrences of nonmelanoma skin cancers and actinic keratoses.
However, data to validate those findings in a larger study group have been lacking, because nicotinamide can be purchased over the counter without being entered into patients’ medical records. In a recent study published by Breglio et al in JAMA Dermatology, researchers found a way to get that data by analyzing records from the Veterans Affairs Corporate Data Warehouse. Nicotinamide is on the VA’s official formulary, so the team checked the outcomes of 33,833 patients for their next skin cancer diagnosis after baseline treatment with 500 mg of nicotinamide twice daily for longer than 30 days. They looked for subsequent occurrences of basal cell carcinoma and cutaneous squamous cell carcinoma.
The researchers compared 12,287 patients who received the treatment with 21,479 who did not. Overall, there was a 14% reduction in skin cancer risk. When nicotinamide was taken after a first skin cancer, the risk reduction rose to 54%, but the benefit declined with treatment initiation after subsequent skin cancers. The risk reduction was much larger for squamous cell carcinoma.
“There are no guidelines for when to start treatment with nicotinamide for skin cancer prevention in the general population. These results would really shift our practice from starting it once patients have developed numerous skin cancers to starting it earlier. We still need to do a better job of identifying who will actually benefit, as roughly only half of patients will develop multiple skin cancers,” said the study’s corresponding author, Lee Wheless, MD, PhD, Assistant Professor of Dermatology and Medicine at Vanderbilt University Medical Center and a staff physician at VA Tennessee Valley Healthcare System.
The researchers were also able to ascertain the outcomes of 1,334 patients who were immunocompromised due to having received solid organ transplants. Among solid organ transplant recipients, no overall significant risk reduction was observed, although early nicotinamide use was associated with reduced occurrences of cutaneous squamous cell carcinoma.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
