Risk of malignancy in patients with systemic lupus erythematosus: Systematic review and meta-analysis

Clarke, Ann E.; Pooley, Nick; Marjenberg, Zoe; Langham, Julia; Nicholson, Lindsay; Langham, Sue; Embleton, Nina; Wang, Xia; Desta, Barnabas; Barut, Volkan; Hammond, Edward R.

doi:10.1016/j.semarthrit.2021.09.009

Cited by 35 publications

(38 citation statements)

References 81 publications

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“…No increase [27,62,63] Increased; IR 0.93-0.99/100 PY [64,65] Risk of VTE Increased; IR of 0.33-0.79/100 PY [66][67][68][69][70][71][72][73][74] Possibly increased [75][76][77]; o IR 0.18-0.24/ 100 PY [76,77] No increase; IR 0.09/100 PY [77] Increased; IR 0.52-1.85/100 PY [74,[78][79][80] Risk of malignancy Increased [81][82][83]; by 10% overall versus general population [81] (lymphoma SIR 2.46, lung SIR 1.64, melanoma SIR 1.3) [81] Reduced for colorectal cancer (SIR 0.77) [81] and some hormone-dependent cancers No increase, except lymphoma [33,51] p Uncertain [84][85][86] Increased, SIR of 1.14 overall, including lymphoma [87,88] Table 1 Definition of obesity varied across studies [33] e Depending on the definition of hypertension [33] f Depending on the definition of CVD: includes coronary artery disease, myocardial infarction, congestive heart failure, stroke, peripheral vascular disease [33] g…”

Section: Methodsmentioning

confidence: 99%

“…The overall risk of malignancy appears to be increased in patients with SLE (Table 1 ), as is the risk of certain cancer types [ 87 , 88 ]. Recent reviews and meta-analyses have confirmed increased rates of all haematological malignancies (particularly non-Hodgkin’s lymphoma) and lung, hepatobiliary (particularly liver), vulvar/vaginal, laryngeal, otopharyngeal, oesophageal, anal, bladder, thyroid, and brain and nervous system malignancies, as well as cervical dysplasia/cancer.…”

Section: Adverse Events Of Special Interest: Baricitinib Clinical Evi...mentioning

confidence: 99%

“…Decreased rates of breast, uterine, melanoma and prostate cancer in SLE have also been shown [ 87 , 88 ]. The risk of hormone-sensitive cancers such as breast, uterine and prostate malignancies may be lower as a result of autoantibody profiles [ 203 , 204 ], and for the last two malignancies, earlier menopause, and/or avoidance of oral contraceptives or hormone-replacement therapy that arises from concerns over adverse outcomes [ 203 ].…”

Section: Adverse Events Of Special Interest: Baricitinib Clinical Evi...mentioning

confidence: 99%

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A Review of Safety Outcomes from Clinical Trials of Baricitinib in Rheumatology, Dermatology and COVID-19

Bieber

Feist²,

Irvine

et al. 2022

Adv Ther

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Baricitinib is an oral, selective inhibitor of Janus kinase (JAK)1/JAK2 that transiently and reversibly inhibits many proinflammatory cytokines. This mechanism is a key mediator in a number of chronic inflammatory diseases; accordingly, baricitinib has been studied and approved for the treatment of several rheumatological and dermatological disorders, as well as COVID-19. This narrative review summarises and discusses the safety profile of baricitinib across these diseases, with special focus on adverse events of special interest (AESI) for JAK inhibitors, using integrated safety data sets of clinical trial data, and puts findings into context with the underlying risk in the respective disease populations, using supporting literature. We show that rates of infection with baricitinib generally reflected the inherent risk of the disease populations being treated, with serious infections and herpes zoster being more frequent in rheumatic diseases than in dermatological disorders, and herpes simplex being reported particularly in atopic dermatitis. Similarly, rates of major adverse cardiovascular events (MACE), venous thromboembolism (VTE) and malignancies were generally within or below the ranges reported for the respective disease populations, thereby reflecting the underlying risk; these events were therefore more frequent in patients with rheumatic diseases than in those with dermatological disorders, the latter of whom generally had low absolute risk. AESI were usually more common in patients with risk factors specific for each event. When a population similar to that of ORAL Surveillance was considered, the incidence rate of MACE with baricitinib was numerically lower than that reported with tofacitinib and similar to that of tumour necrosis factor inhibitors. No safety concerns were observed in hospitalised patients with COVID-19 who received baricitinib for up to 14 days. Identifying the patterns and likelihoods of AEs that occur during treatment in large groups of patients with different diseases can help the physician and patient better contextualise the benefit-to-risk ratio for the individual patient.

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Section: Methodsmentioning

confidence: 99%

Section: Adverse Events Of Special Interest: Baricitinib Clinical Evi...mentioning

confidence: 99%

Section: Adverse Events Of Special Interest: Baricitinib Clinical Evi...mentioning

confidence: 99%

See 1 more Smart Citation

A Review of Safety Outcomes from Clinical Trials of Baricitinib in Rheumatology, Dermatology and COVID-19

Bieber

Feist²,

Irvine

et al. 2022

Adv Ther

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“…6,8 There is data suggesting that SLE patients have increased rates of cervical dysplasia and precancerous lesions, but an increased risk for outright cervical cancer is not observed in many SLE cohorts, likely due to the effectiveness of cervical cancer screening programs in these patient populations. 10 SLE patients have also been noted to have decreased risk for some solid tumor malignancies, including melanoma 2,6,8,9 and cancers of the breast, 1,2,9 uterus, 1,2,9 ovary, 3,7 and prostate. 2,3,[5][6][7][8][9] This unique profile of cancer risk among SLE patients has sparked a slew of investigations into the potential risk factors that may underlie malignancy in this population.…”

Section: Introductionmentioning

confidence: 99%

Factors mediating cancer risk in systemic lupus erythematosus

Hardenbergh

Molina

Naik

et al. 2022

Lupus

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Patients with systemic lupus erythematosus (SLE) are at an elevated risk for certain cancers compared to the population at large. Cancers seen at higher rates in the SLE population include hematologic malignancies, such as non-Hodgkin lymphoma, and cancers of the lung and thyroid. SLE patients also have a decreased risk for certain malignancies, such as breast cancer, melanoma, and prostate cancer. We review the literature on risk factors for malignancy in patients with SLE and discuss the exogenous and innate factors that are thought to contribute to the unique pattern of cancer risk observed in this patient population. These risk factors are important for providers of SLE patients to understand in order to maintain high clinical suspicion and detect malignancy as soon as possible. Further research is needed to determine the most effective guidelines on counseling patients on cancer screening and prevention.

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“…For example, systemic lupus erythematosus (SLE) is associated with a significant reduction of several malignancies (breast, endometrial, prostate, and uterine cancers, melanoma). 18 , 19 Rheumatoid arthritis is linked to significantly reduced incidence of breast, colorectal and prostate cancer. 1 , 20 Breast cancer is also significantly less frequent in patients with psoriatic or enteropathic arthropathies ( Figure 1b ).…”

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confidence: 99%

Beneficial autoimmunity and maladaptive inflammation shape epidemiological links between cancer and immune-inflammatory diseases

et al. 2022

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Chronic inflammation drives proliferative responses, hence increasing cellular multiplication with the consequent risk of malignant transformation. Autoimmune responses against self-antigens drive chronic inflammation but may also enhance cancer immunosurveillance with the consequent reduction of tumor incidence and progression. These notions, which have been well established at the preclinical level, may explain the generally positive associations between immune-inflammatory diseases but also some negative associations, for example between breast cancer and rheumatoid arthritis or systemic lupus erythematosus, which have recently been confirmed in a study enrolling close to half a million participants from the UK Biobank.

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Risk of malignancy in patients with systemic lupus erythematosus: Systematic review and meta-analysis

Cited by 35 publications

References 81 publications

A Review of Safety Outcomes from Clinical Trials of Baricitinib in Rheumatology, Dermatology and COVID-19

A Review of Safety Outcomes from Clinical Trials of Baricitinib in Rheumatology, Dermatology and COVID-19

Factors mediating cancer risk in systemic lupus erythematosus

Beneficial autoimmunity and maladaptive inflammation shape epidemiological links between cancer and immune-inflammatory diseases

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