Methotrexate and melanoma‐specific mortality

Polesie, Sam; Gillstedt, Martin; Paoli, John; Osmancevic, Amra

doi:10.1111/jdv.15305

Cited by 3 publications

(4 citation statements)

References 11 publications

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“…For methotrexate use, melanoma risk increased for users of ≥8 prescriptions, which is also in line with previous observations. [21][22][23] However, no association with melanoma was found for "Other drugs with immunosuppressant actions", and we were not able to clarify the indeterminate findings in previous studies for these drugs. [61][62][63] We found that use of immunosuppressants increased the risk of all histological subtypes of melanoma, which could be indicative of a common mechanism of effect.…”

Section: Discussioncontrasting

confidence: 64%

“…20 Methotrexate is a commonly prescribed immunosuppressant, used to treat inflammatory and autoimmune disorders, such as rheumatoid arthritis and psoriasis. Studies indicate an association between methotrexate use and risk of melanoma and melanomaspecific mortality, [21][22][23] although no dose-response association has been discovered. 24 Other drugs with immunosuppressant actions, commonly used to treat these diseases, are also suggested to increase the melanoma risk.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Use of Immunomodulating Drugs and Risk of Cutaneous Melanoma: A Nationwide Nested Case-Control Study</p>

Berge

Andreassen

Stenehjem

et al. 2020

CLEP

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Purpose Cutaneous melanoma is among the fastest growing malignancies in Norway and ultraviolet radiation (UVR) exposure is the primary environmental risk factor. Immunomodulating drugs can increase skin photosensitivity and suppress immune responses, and by such mechanisms influence melanoma risk. We, therefore, aimed to examine the associations between use of immunomodulating drugs and melanoma risk, at a nationwide population level. Patients and Methods In the Cancer Registry of Norway, we identified all cases aged 18–85 with a first primary cutaneous melanoma diagnosed in 2007–2015 (n=12,106). These were matched to population controls from the Norwegian National Registry 1:10 (n=118,564), on sex and year of birth using risk set sampling. Information on prescribed drugs (2004–2015) was obtained by linkage to the Norwegian Prescription Database (NorPD). Conditional logistic regression was used to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for associations between use of immunomodulating drugs (immunosuppressants and corticosteroids) and melanoma risk, adjusted for ambient UVR and other drug use. Results Compared with ≤1 prescription, use of ≥8 prescriptions of immunosuppressants was associated with increased risk of melanoma (RR 1.50, 95% CI 1.27, 1.77). Similar associations were found for subgroups of immunosuppressants: drugs typically prescribed to organ transplant recipients (OTRs) (RR 2.02, 95% CI 1.35, 3.03) and methotrexate (RR 1.27, 95% CI 1.04, 1.55). Similar results were found for high levels of cumulative doses and across all histological subtypes. Use of corticosteroids was not associated with melanoma risk. Conclusion We found a positive association between use of immunosuppressants and melanoma risk, with the highest risk seen for drugs prescribed to OTRs. Knowledge about this risk increase is important for physicians and users of these drugs, for intensified surveillance, awareness and cautious sun exposure.

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Section: Discussioncontrasting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

<p>Use of Immunomodulating Drugs and Risk of Cutaneous Melanoma: A Nationwide Nested Case-Control Study</p>

Berge

Andreassen

Stenehjem

et al. 2020

CLEP

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“…Interestingly, the risk for melanoma in patients with psoriasis may be lower than in individuals without psoriasis 66 . In psoriasis patients with a history of melanoma, we recommend using the conventional drugs, acitretin, fumarates and methotrexate, as systemic therapy 78–81 …”

Section: Resultsmentioning

confidence: 99%

“…66 In psoriasis patients with a history of melanoma, we recommend using the conventional drugs, acitretin, fumarates and methotrexate, as systemic therapy. [78][79][80][81] When using the anti-TNFa drugs, adalimumab, certolizumab pegol, etanercept, and infliximab, and the IL-12/23 inhibitor, ustekinumab, we note that the BAD guidelines recommend waiting for 5 years before starting these biological therapies in psoriasis patients with a history of melanomas. 67 Exposure to TNFa inhibitors has been linked to an increased development of melanoma, and cases with metastatic melanoma under TNFa inhibition have been reported.…”

Section: Malignancies/cancermentioning

confidence: 99%

Practical recommendations for systemic treatment in psoriasis in case of coexisting inflammatory, neurologic, infectious or malignant disorders (BETA‐PSO: Belgian Evidence‐based Treatment Advice in Psoriasis; part 2)

Lambert

Segaert²,

Ghislain

et al. 2020

Acad Dermatol Venereol

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Background Psoriasis patients carry an increased risk for associated comorbidities. Dermatologists have to be aware of the effects of systemic treatments not only on psoriasis but also on co‐occurring diseases. In case of other coexisting inflammatory diseases, the right psoriasis treatment may improve both disorders. For infectious and malignant disorders, some treatments have to be avoided as they may be harmful. Objective The primary objective of this project was to collect evidence for the creation of practice guidelines for systemic treatment of psoriasis (BETA‐PSO: Belgian Evidence‐based Treatment Advice in Psoriasis). Methods Evidence‐based recommendations were formulated using a quasi‐Delphi methodology after a systematic search of the literature and a consensus procedure involving eight psoriasis experts. Results Recommendations are given on the use of systemic treatment in psoriatic arthritis, inflammatory bowel disease, demyelinating disorders, hepatitis B and C, HIV and cancer. Conclusion This expert opinion is a practical guide for dermatologists when handling psoriasis patients with these specific conditions.

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Management of rheumatic complications of immune checkpoint inhibitor therapy – an oncological perspective

Steven

Fisher

2019

Rheumatology

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Immune checkpoint inhibitors (CPIs) are an effective treatment for many cancers but cause diverse immune-related adverse events (IrAEs). Rheumatological IrAEs include arthralgia, arthritis, tenosynovitis, myositis, polymyalgia rheumatica and sicca syndrome. CPI use can unmask RA as well as causing flares of prior autoimmune or connective tissue disease. Oncologists categorize and grade IrAEs using the Common Terminology Criteria for Adverse Events and manage them according to international guidelines. However, rheumatological events are unfamiliar territory: oncologists need to work with rheumatologists to elicit and assess symptoms, signs, results of imaging and autoantibody testing and to determine the use of steroids and DMARDs. Myositis may overlap with myasthenic crisis and myocarditis and can be life-threatening. Treatment should be offered on balance of risk and benefit, including whether to continue CPI treatment and recognizing the uncertainty over whether glucocorticoids and DMARDs might compromise cancer control.

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Methotrexate and melanoma‐specific mortality

Cited by 3 publications

References 11 publications

<p>Use of Immunomodulating Drugs and Risk of Cutaneous Melanoma: A Nationwide Nested Case-Control Study</p>

<p>Use of Immunomodulating Drugs and Risk of Cutaneous Melanoma: A Nationwide Nested Case-Control Study</p>

Practical recommendations for systemic treatment in psoriasis in case of coexisting inflammatory, neurologic, infectious or malignant disorders (BETA‐PSO: Belgian Evidence‐based Treatment Advice in Psoriasis; part 2)

Management of rheumatic complications of immune checkpoint inhibitor therapy – an oncological perspective

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