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NEW YORK (Reuters Health) Jan 16 - Results of a new study provide more evidence that immunosuppressive drug therapy may contribute to an increased risk of hematologic malignancies in patients with systemic lupus erythematosus (SLE).
In SLE and several other types of systemic autoimmune diseases, there is "increasing evidence" that cancer, particularly hematological and lung cancers, contributes to morbidity and mortality, the study team notes.
To investigate further, Dr. Sasha Bernatsky of McGill University Health Centre in Montreal, Quebec, and colleagues conducted a case-control study within an international SLE cohort. They focused on 246 cancer cases, including 46 hematologic malignancies and 35 lung cancers, and 538 cancer-free controls.
According to their report in the January issue of the Annals of the Rheumatic Diseases, multivariate models suggested that overall cancer risk in SLE was associated with age 65 or older (hazard ratio, 2.69) and the presence of non-malignancy SLE damage (HR, 3.07). For lung cancer, smoking also appeared to be a risk factor (HR, 3.60), as expected.
According to Dr. Bernatsky and colleagues, the adjusted hazard ratio for overall cancer risk after cyclophosphamide, azathioprine, or methotrexate therapy was 0.82. However, in analyses looking specifically at the 46 patients with hematologic malignancies, "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)," the team reports.
"Our results set the stage for future evaluations of long-term effects of emerging (immunosuppressive) agents," Dr. Bernatsky and colleagues write. They also note that studies evaluating the independent influence of medication exposures and disease activity on risk of malignancy are in progress.
Ann Rheum Dis 2008;67:74-79.
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