Risk of high-grade cervical dysplasia and cervical cancer in women with systemic lupus erythematosus receiving immunosuppressive drugs

Abstract

Objective Prior studies suggest an increased risk of cervical cancer among women with systemic lupus erythematosus (SLE). However, the relationship with immunosuppressive drugs (ISDs) is not well studied in U.S. nationwide cohorts. We compared the risk of high-grade cervical dysplasia and cervical cancer among women with SLE who started ISDs versus hydroxychloroquine (HCQ). Methods We identified SLE patients initiating ISD or HCQ using claims data from two US commercial health plans and Medicaid (2000–2012). We used a validated claims-based algorithm to identify high-grade cervical dysplasia or cervical cancer. To account for potential confounders including demographic factors, comorbidities, medication use, HPV vaccination status, and health care utilization, ISD and HCQ initiators were 1:1 matched on the propensity score (PS). We used inverse variance-weighted, fixed effect models to pool hazard ratios (HR) from the PS-matched Medicaid and commercial cohorts. Results We included 2,451 matched pairs of ISD and HCQ new users in the commercial cohort and 7,690 matched pairs in Medicaid. In the commercial cohort, there were 14 cases of cervical dysplasia or cervical cancer among ISD users and 5 cases among HCQ users (HR 2.47, 95% CI 0.89–6.85, HCQ=ref). In Medicaid, there were 46 cases among ISD users and 29 cases in HCQ users (HR 1.24, 95% CI 0.78–1.98, HCQ=ref). The pooled HR of ISD was 1.40 (95% CI 0.92–2.12). Conclusion Among women with SLE, ISDs may be associated with a greater, albeit not statistically significant, risk of high-grade cervical dysplasia and cervical cancer compared to patients receiving HCQ alone.

Unbiased prediction modeling for discovery research in nonalcoholic fatty liver disease

“…Additional findings identified by following our methodology were consistent with the literature, such as those for calcium [22] and chloride [23]. SLE has been associated with the development of cervical cancer, and our results were similar [11]. Our results suggest that cervical cancer may precede the development of SLE, contrary to proposals that SLE predisposes a patient to cervical cancer.…”

“…As expected, Parkinson's disease was associated with a subsequent indication for falls and with a wide range of mental conditions including mood disorders, dementia, and schizophrenia. In addition, systemic lupus erythematosus (SLE) has broadly been described as being linked to the development of cervical cancer [11]. Indeed, our methodology highlighted a strong association between the two diseases.…”

HPV vaccination of immunocompromised hosts

“…In addition for males and females who are HIV-positive there is a higher risk of HR-HPV anal infection, anal HSIL and anal cancer [37] , [38] . Although this association is presumably due to impaired ability to clear HPV and increased reactivation of latent infection [39] , [40] , [41] , [42] , [43] , [44] , [45] , other mechanisms may be involved that result in cellular immune dysfunction [46] , [47] .…”

Electronic Medical Records for Discovery Research in Nonalcoholic Fatty Liver Disease

“…As expected, Parkinson's disease was associated with a subsequent indication for falls and with a wide range of mental conditions including mood disorders, dementia, and schizophrenia. In addition, systemic lupus erythematosus (SLE) has broadly been described as being linked to the development of cervical cancer [11]. Indeed, our engine highlighted a strong association between the two diseases.…”