Risk of Non-melanoma Skin Cancer in Patients with Atopic Dermatitis Treated with Oral Immunosuppressive Drugs

Abstract

There is uncertainty about the risk of developing non-melanoma skin cancer (NMSC), including basal cell carcinoma and squamous cell carcinoma (SCC), in patients with atopic dermatitis (AD) treated with oral immunosuppressive drugs. A total of 557 patients with AD treated with these drugs in the University Medical Center Utrecht and Groningen, the Netherlands, were analysed. NMSC after oral immunosuppressive treatment was reported in 18 patients (3.2%). The standardized incidence ratio for developing SCC was 13.1 (95% confidence interval (95% CI) 6.5-19.7). Patients developing NMSC were older at the start of therapy (p<0.001) and data lock (p<0.001) compared with patients without NMSC. No significant differences were found in sex, cumulative days of oral immunosuppressive drugs and follow-up between these groups (p=0.42, p=0.88, and p=0.34, respectively). In interpreting these results it is important to include other factors, such as lack of association between treatment duration and tumour development and the long interval between treatment discontinuation and tumour development in some patients.

Dupilumab with concomitant topical corticosteroid treatment in adults with atopic dermatitis with an inadequate response or intolerance to ciclosporin A or when this treatment is medically inadvisable: a placebo-controlled, randomized phase III clinical t

“…Oral CsA is a broad immunosuppressant prescribed for patients with severe atopic dermatitis whose disease warrants systemic treatment. Although it may be effective in the short term in patients with severe atopic dermatitis, use of CsA is limited because of the risk of several types of side‐effects, and the label restricts use to 1 year . In addition, cessation of CsA treatment can lead to disease rebound, which is difficult to manage.…”

“…Side‐effects associated with CsA include hypertension, nephrotoxicity and subjective side‐effects (e.g. headache, paraesthesia in fingers and toes, fatigue) . Its use is also limited by contraindications because of other medical conditions.…”

“…CsA suppresses Th1, Th2 and Th17/22, affecting both humoral and cellular immune responses . Long‐term use (beyond 1 year) of CsA, as may be required in atopic dermatitis, is limited by risk of side‐effects, although off‐label use beyond 1 year has been reported . Side‐effects associated with CsA include hypertension, nephrotoxicity and subjective side‐effects (e.g.…”

Atopic Dermatitis in Older Adults: A Review of Treatment Options

“…Oral cyclosporine is also effective for the treatment of severe cases of elderly AD when administered at an optimal and sufficient dose (e.g., 3 mg/kg/day) [39,80]. However, clinicians must pay attention to long-term use of cyclosporine in older patients with AD due to the potential increased risks of malignancy such as non-melanoma skin cancer or lymphoma [81,82] and organ toxicity, especially in the cardiovascular system and kidney [43,80,83]. Therefore, the duration of use of oral cyclosporine for older patients with AD should be no longer than 12 weeks, although it could be restarted intermittently after withdrawal of 2 weeks or more [39].…”

Clinical and immunological allergy assessment in cancer patients

“…According to the immune surveillance concept, the immune system destroys neoplastic cells by means of innate immunity, responsible for immediate detection and destruction of malignant cells 12 , 13 . In primary or acquired immunodeficiency, as in acquired immunodeficiency syndrome, when immunosuppressants are used, and in elderly patients, there is a predisposition or a higher probability for the occurrence of cancer 14 – 17 .…”