Risk of Cancers in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Results from the Korea National Health Insurance Claims Database 2010–2018

Ahn, Sung Soo; Han, Minkyung; Yoo, Juyoung; Jung, Seung Min; Song, Jason Jungsik; Park, Yong‐Beom; Jung, Inkyung; Lee, Sang Won

doi:10.3390/jcm8111871

Cited by 10 publications

(20 citation statements)

References 52 publications

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“…To identify SNV patients, the respective ICD-10 codes for MPA (M31.7), GPA (M31.3), EGPA (M30.1), and PAN (M30.0) were used. Patients were diagnosed with SNV when they were first registered with the corresponding ICD-10 codes for AAV or PAN in a general or tertiary hospital and were prescribed with glucocorticoids (betamethasone, dexamethasone, methylprednisolone, prednisone, prednisolone, hydrocortisone, triamcinolone, budesonide, and deflazacort) during the follow-up period ( 19 ). The date on which the diagnosis of SNV was first registered in the HIRA database was defined as the index date, and the medications of immunosuppressive agents (glucocorticoids, cyclophosphamide, rituximab, azathioprine/mizoribine, and methotrexate), antiplatelet agents (aspirin, clopidogrel), and statins that were prescribed after the diagnosis of SNV were also counted.…”

Section: Methodsmentioning

confidence: 99%

Risk of Stroke in Systemic Necrotizing Vasculitis: A Nationwide Study Using the National Claims Database

et al. 2021

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ObjectiveEvidences indicate that the risk of stroke is increased in autoimmune rheumatic diseases. This study aimed to investigate the incidence of stroke in patients with systemic necrotizing vasculitis (SNV) using the national health database.MethodsData were obtained from the Korean National Claims database between 2010 and 2018 to identify incident SNV [anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and polyarteritis nodosa (PAN)] cases. The standardized incidence ratio (SIR) and incidence rate ratio (IRR) were calculated to estimate the risk of stroke in patients with SNV compared to the general population and among disease subgroups. Time-dependent Cox’s regression analysis was performed to identify risk factors for stroke.ResultsAmong 2644 incident SNV cases, 159 patients (6.0%) were affected by stroke. The overall risk of stroke was significantly higher in patients with SNV compared to the general population (SIR 8.42). Stroke event rates were the highest within the first year of SNV diagnosis (67.3%). Among disease subgroups, patients with microscopic polyangiitis (MPA) exhibited higher IRR compared to PAN (adjusted IRR 1.98). In Cox’s hazard analysis, older age and MPA were associated with higher risk of stroke [hazard ratio (HR) 1.05 and 1.88], whereas the administration of cyclophosphamide, azathioprine/mizoribine, methotrexate, and statins were protective in stroke (HR 0.26, 0.34, 0.49, and 0.50, respectively).ConclusionA considerable number of SNV patients experienced stroke, especially in the early phase of disease. Older age and MPA diagnosis were associated with elevated risk of stroke, while the administration of immunosuppressive agents and statins was beneficial in preventing stroke.

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Section: Methodsmentioning

confidence: 99%

Risk of Stroke in Systemic Necrotizing Vasculitis: A Nationwide Study Using the National Claims Database

et al. 2021

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“…CYC therapy is also associated with increased risk of haematologic malignancies. In addition to significantly increased SIRs for lung cancer (SIR 2.32) and kidney cancer (SIR 5.01) in CYC‐treated SLE patients, Soo Ahn et al (2019) found increased SIR (SIR 13.82) for haematological cancer in these patients as well 23 . A retrospective case–control study (LoE 3b) of 75 SLE patients being treated with various immunosuppressive agents, including CYC, found patients who developed lymphoma had greater exposure to CYC therapy than other immunosuppressants 48 …”

Section: Resultsmentioning

confidence: 98%

“…Soo Ahn et al (2019) found that the overall cancer risk was significantly higher in these patients (SIR 1.90). Patients who were administered with combination AZA/mizoribine had a significantly higher risk of kidney cancer (SIR 5.46), haematological cancer (SIR 5.67) and “other remaining” cancers (SIR 3.25) which were coded by the researchers 23 . However, as these patients used both AZA and mizoribine are confounder and limit the conclusions that can made about the risk for malignancy in AZA alone.…”

Section: Resultsmentioning

confidence: 99%

Malignancy risk of non‐biologic immunosuppressive therapies: A review of the literature with evidence‐based treatment recommendations

Stratman

Golpanian

Fayne

et al. 2022

Experimental Dermatology

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Non‐biologic immunosuppressive therapies are a mainstay in the treatment of various dermatologic conditions. However, the use of these therapies has been scrutinized for potentially increasing risk of haematologic or solid‐organ malignancies. Currently, there are no evidence‐based guidelines stratifying the risk of malignancy in patients receiving these immunosuppressive agents for the treatment of dermatologic disease. In our review, we evaluate the risk of solid organ and haematologic malignancies in patients receiving non‐biologic immunosuppressant therapy for dermatologic indications. A literature search was conducted on PubMed/MEDLINE. Search terms included commonly prescribed non‐biologic immunosuppressants and common dermatologic conditions for which non‐biologic immunosuppressants are typically prescribed. Levels of evidence and grades of recommendation were used for guidelines. All immunosuppressants evaluated, with the exception of cyclophosphamide, demonstrated low solid‐organ or haematologic malignancy potential. Co‐morbidities may play a role in malignancy risk in the context of immunosuppressant treatment, including autoimmune disease, which have been associated with increased risk of malignancy and confound overall risk. Duration and/or dosage of treatment may influence this risk as well. Limitations of the review include that the majority of studies were of small sample size, retrospective in nature, and there was lack of direct comparison trials.

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“…We defined our patients as having SNV when they were diagnosed as AAV or PAN at a general or tertiary care hospital and were prescribed with glucocorticoids (methylprednisolone, hydrocortisone, prednisone, prednisolone, triamcinolone, budesonide, betamethasone, dexamethasone, or deflazacort) during the follow-up. To select SNV cases, the corresponding International Classification of Diseases (ICD)-10 codes for microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA), and PAN (M31.7, M31.3, M30.1, and M30.0, respectively) were used (20). Concerning the medications used by patients after the diagnosis of SNV and prior to the incidence of TB, the usage of glucocorticoids, cyclophosphamide, rituximab, azathioprine, and methotrexate was determined.…”

Section: Patient Selection and Data Extractionmentioning

confidence: 99%

“…On comparing the risk of TB according to 10-year age intervals, the risk of TB was significantly higher in all age groups of SNV, except for those aged 0-19 and 50-59 years. In particular, SIRs of TB were the highest in patients aged20-29 and 30-39 years (SIR 14.30, 95% CI 3.90-36.62; SIR 14.86, 95% CI 4.83-34.68). The risk of TB was equally high in patients with SNV regardless of sex (SIR 5.95, 95% CI 3.96-8.60 in men and SIR 6.26, 95% CI 3.97-9.39 in women).…”

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confidence: 97%

Incidence of Tuberculosis in Systemic Necrotizing Vasculitides: A Population-Based Study From an Intermediate-Burden Country

et al. 2020

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Objective: Tuberculosis (TB) has a significant impact on public health; however, its incidence in patients with systemic necrotizing vasculitides (SNV) remains unknown. Therefore, we evaluated the incidence of TB in patients with SNV using a nationwide claims database. Methods: The Health Insurance and Review Agency database was used to identify patients diagnosed with SNV between 2010 and 2018. The standardized incidence ratio (SIR) was calculated to compared the risk of TB between patients and the general population, based on the 2016 annual national TB report. The incidence of TB after SNV diagnosis was compared by estimating age-and sex-adjusted incidence rate ratio (IRR). A time-dependent Cox regression analysis was performed to estimate factors associated with TB. Results: Among the included 2,660 patients, 51 (1.9%) developed TB during the follow-up period. The risk of TB was significantly higher in patients with SNV [SIR 6.09, 95% confidence interval (CI) 4.53-8.00], both in men (SIR 5.95) and women (SIR 6.26), than in the general population; this increased risk was consistent in all disease subtypes, except eosinophilic granulomatosis with polyangiitis. Additionally, the incidence of TB was the highest in patients with SNV within the first 3 months after diagnosis (adjusted IRR: 8.90 compared to TB ≥ 12 months). In Cox regression analysis, the diagnosis of microscopic polyangiitis [hazard ratio (HR) 3.22, 95% CI 1.04-9.99], granulomatosis with polyangiitis (HR 4.63, 95% CI 1.53-14.02), and polyarteritis nodosa (HR 3.51, 95% CI 1.13-10.88) were independent factors associated with TB. Conclusion: Even when considering the high incidence of TB in the geographic region, the risk of TB increased in patients with SNV, with a difference based on disease subtypes. Moreover, taking into account of the high Ahn et al. TB in SNV incidence of TB in SNV, vigilant monitoring for TB is required especially during the early disease period.

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Risk of Cancers in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Results from the Korea National Health Insurance Claims Database 2010–2018

Cited by 10 publications

References 52 publications

Risk of Stroke in Systemic Necrotizing Vasculitis: A Nationwide Study Using the National Claims Database

Risk of Stroke in Systemic Necrotizing Vasculitis: A Nationwide Study Using the National Claims Database

Malignancy risk of non‐biologic immunosuppressive therapies: A review of the literature with evidence‐based treatment recommendations

Incidence of Tuberculosis in Systemic Necrotizing Vasculitides: A Population-Based Study From an Intermediate-Burden Country

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