Hydroxychloroquine and risk of development of cancers: a nationwide population-based cohort study

Abstract

BackgroundHydroxychloroquine (HCQ), one of the disease-modifying antirheumatic drugs, may lead to an inhibition of autophagy. Autophagy, an intracellular self-defense mechanism for the lysosomal degradation of cytoplasmic components such as damaged organelles, plays a role in protecting against neoplasm growth but is also vital for cancer cells due to an increased intracellular metabolic waste.MethodsTaiwan National Health Insurance Database was subjected to analysis to investigate the effect of HCQ exposure on cancer risk in patients with autoimmune diseases. Cancer incidence between patients with or without at least 12-month HCQ use was compared by propensity score-matched landmark analysis. A total of 100,000 participants were enrolled, including 7,662 patients who were diagnosed with autoimmune diseases between January 1, 2000, and December 31, 2012.ResultsAfter propensity score matching, HCQ user and nonuser groups consist of 1,933 patients with a mean follow-up time of 7.82 and 6.7 years, respectively. During the follow-up period, 93 HCQ users and 77 HCQ nonusers developed cancers. Meanwhile, Kaplan–Meier estimates showed no difference in the overall incidence of cancer between HCQ users and nonusers.ConclusionThis propensity score-matched study of Taiwanese patients with autoimmune diseases suggested that HCQ exposure did not increase the cancer risk.

Safety of Immunomodulatory Systemic Therapies Used in the Management of Immune-Related Cutaneous Adverse Events

“…Common AEs associated with hydroxychloroquine use include gastrointestinal symptoms, headaches, and rashes [66]. There does not appear to be an elevated risk of malignancy with hydroxychloroquine use [67][68][69]. In fact, numerous preclinical models have shown that hydroxychloroquine can induce tumor suppression and may help overcome chemotherapy resistance [70].…”

Hydroxychloroquine: From Pharmacological Profile to Neglected Adverse Reactions

“…It prevents the accumulation of damaged proteins and organelles as a tumor suppressor, while also as a tumor promotor it facilitates tumor growth and aggressiveness by surviving microenvironmental stress. Fortunately, in a nationwide population-based cohort study, Mao et al showed that the use of HCQ was not associated with an increased risk of cancer in patients with autoimmune diseases (50). Nevertheless, it is obvious that further investigations in well-designed studies and large welldefined cohorts are required before more clear conclusions can be drawn.…”