Polesie S, Gillstedt M, Paoli J, Osmancevic A
Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden.
Br J Dermatol. 2020 Oct;183(4):684-691. doi: 10.1111/bjd.18887. Epub 2020 Mar 4.
Cutaneous malignant melanoma (CMM) is a highly immunogenic tumour. Patients with an impaired immune system have an enhanced risk for CMM and a worse prognosis. Methotrexate (MTX) is an anti-inflammatory and immunosuppressive drug frequently used to treat patients with psoriasis. An association between MTX and risk of CMM has previously been demonstrated in patients with rheumatoid arthritis.
To investigate whether MTX increases the risk of CMM among patients with psoriasis.
A nested case-control investigation from a Swedish cohort of patients with psoriasis was conducted. Data were obtained from available Swedish registers and included 395 patients with psoriasis who had previously been cancer-free and had a first CMM in the time period from 1 January 2010 to 31 December 2016. A total of 10 randomly selected cancer-free patients with psoriasis were matched per case with respect to age (same birth year) and sex. The accumulated MTX doses in both groups were obtained. Crude odds ratios (ORs) for the proportion of MTX in the respective group were calculated using conditional logistic regression analyses.
Of 395 patients with psoriasis who had CMM, 97 (25%) had filled a prescription of MTX; of 3950 controls, the corresponding number was 954 (24%). In a conditional logistic regression analysis, no association between MTX exposure (ever use) and risk for CMM was observed (OR 1·0, 95% confidence interval 0·8-1·3). Moreover, no indication of a dose-response association was observed.
In this Swedish nested case-control study, the use of MTX was not associated with an enhanced risk for CMM. These findings are reassuring for dermatologists in everyday clinical practice. What is already known about this topic? Methotrexate (MTX) treatment has been linked to an increased risk for cutaneous malignant melanoma (CMM) in an Australian cohort of patients with rheumatoid arthritis. In a previous retrospective Swedish cohort investigation, patients who had exclusively been prescribed MTX by a dermatologist did not have an enhanced risk for CMM compared with MTX-unexposed individuals. Nevertheless, this cohort did not specifically include patients with psoriasis. What does this study add? This Swedish nested case-control investigation included 395 previously cancer-free patients with psoriasis who had CMM (cases) and 3950 matched cancer-free patients with psoriasis (controls). No association between MTX exposure and risk for CMM in patients with psoriasis was observed. The results are reassuring for dermatologists using MTX to treat patients with psoriasis. Linked Comment: Haugaard and Egeberg. Br J Dermatol 2020; 183:608-609.
皮肤恶性黑色素瘤（CMM）是一种高度免疫原性肿瘤。免疫系统受损的患者患CMM的风险增加且预后较差。甲氨蝶呤（MTX）是一种常用于治疗银屑病患者的抗炎和免疫抑制药物。先前已证实在类风湿性关节炎患者中MTX与CMM风险之间存在关联。
调查MTX是否会增加银屑病患者患CMM的风险。
对瑞典银屑病患者队列进行了一项巢式病例对照研究。数据来自瑞典现有的登记资料，包括395例既往无癌症且在2010年1月1日至2016年12月31日期间首次发生CMM的银屑病患者。每例病例随机选取10例年龄（同年出生）和性别匹配的无癌银屑病患者作为对照。获取两组的MTX累积剂量。使用条件逻辑回归分析计算各组中MTX比例的粗比值比（OR）。
在395例发生CMM的银屑病患者中，97例（25%）曾开具过MTX处方；在对照组的3950例患者中，相应数字为954例（24%）。在条件逻辑回归分析中，未观察到MTX暴露（曾使用）与CMM风险之间存在关联（OR 1.0，95%置信区间0.8 - 1.3）。此外，未观察到剂量反应关联的迹象。
在这项瑞典巢式病例对照研究中，MTX的使用与CMM风险增加无关。这些发现让皮肤科医生在日常临床实践中感到安心。关于该主题已知的信息有哪些？在澳大利亚类风湿性关节炎患者队列中，甲氨蝶呤（MTX）治疗与皮肤恶性黑色素瘤（CMM）风险增加有关。在瑞典之前的一项回顾性队列研究中，与未接触MTX的个体相比，仅由皮肤科医生开具MTX处方的患者患CMM的风险并未增加。然而，该队列并未专门纳入银屑病患者。本研究补充了什么？这项瑞典巢式病例对照研究纳入了395例既往无癌症且发生CMM的银屑病患者（病例组）和�950例匹配的无癌银屑病患者（对照组）。未观察到银屑病患者中MTX暴露与CMM风险之间存在关联。这些结果让使用MTX治疗银屑病患者的皮肤科医生感到安心。相关评论：Haugaard和Egeberg。《英国皮肤病学杂志》2020年；183：608 - 609。
