Chien Hsu-Chih, Kao Yang Yea-Huei, Kwoh C Kent, Chalasani Pavani, Wilson Debbie L, Lo-Ciganic Wei-Hsuan
Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine and Health Outcome Research Center, National Cheng Kung University, Tainan 701, Taiwan.
School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.
J Clin Med. 2020 Feb 19;9(2):566. doi: 10.3390/jcm9020566.
Tamoxifen or aromatase inhibitor (AI) therapy may prevent breast cancer recurrence, however, adverse effects may lead to treatment discontinuation. Evidence regarding the occurrence of AI-associated musculoskeletal problems among Asians is scarce. We identified women with breast cancer-initiating tamoxifen or AIs from the Taiwan National Health Insurance Research Database (2007-2012). Using multivariable cause-specific hazard models, we examined the association between endocrine therapy and the risk of any arthritis and carpal tunnel syndrome, adjusting for age, prior cancer treatment, and other health status factors. Among 32,055 eligible women with breast cancer (mean age = 52.6 ± 11.5 years), 87.4% initiated tamoxifen, 3.9% initiated anastrozole, 8.0% initiated letrozole, and 0.7% initiated exemestane. AI users had a higher 1-year cumulative incidence for any arthritis (13.0% vs. 8.2%, < 0.0001) and carpal tunnel syndrome (1.4% vs. 0.8%, = 0.008). Compared to tamoxifen users, AI users had a higher risk of any arthritis [adjusted hazard ratio (aHR) = 1.21, 95%CI = 1.09-1.34] and carpal tunnel syndrome (aHR = 1.68, 95%CI = 1.22-2.32). No significant difference was observed in the risks of any arthritis and carpal tunnel syndrome across different AIs. Taxane use was not associated with any arthritis (aHR = 0.92, 95%CI = 0.81-1.05) or carpal tunnel syndrome (aHR = 0.97, 95%CI = 0.67-1.40) compared to other chemotherapies. Taiwanese women with breast cancer-initiating AIs had an increased risk of arthritis and carpal tunnel syndrome compared to those who initiated tamoxifen.
他莫昔芬或芳香化酶抑制剂（AI）治疗可能预防乳腺癌复发，然而，不良反应可能导致治疗中断。关于亚洲人中与AI相关的肌肉骨骼问题发生情况的证据很少。我们从台湾国民健康保险研究数据库（2007 - 2012年）中识别出开始使用他莫昔芬或AI的乳腺癌女性。使用多变量特定病因风险模型，我们研究了内分泌治疗与任何关节炎和腕管综合征风险之间的关联，并对年龄、既往癌症治疗及其他健康状况因素进行了调整。在32,055名符合条件的乳腺癌女性（平均年龄 = 52.6 ± 11.5岁）中，87.4%开始使用他莫昔芬，3.9%开始使用阿那曲唑，8.0%开始使用来曲唑，0.7%开始使用依西美坦。AI使用者中任何关节炎的1年累积发病率更高（13.0%对8.2%，<0.0001），腕管综合征的1年累积发病率也更高（1.4%对0.8%，=0.008）。与他莫昔芬使用者相比,AI使用者患任何关节炎的风险更高[调整后风险比（aHR）=1.21，95%置信区间（CI）=1.09 - 1.34]，患腕管综合征的风险更高（aHR = 1.68，95%CI = 1.22 - 2.32）。在不同AI之间，任何关节炎和腕管综合征的风险未观察到显著差异。与其他化疗相比，使用紫杉烷与任何关节炎（aHR = 0.92，95%CI = 0.81 - 1.05）或腕管综合征（aHR = 0.97，95%CI = 0.67 - 1.40）无关。与开始使用他莫昔芬的台湾乳腺癌女性相比，开始使用AI的女性患关节炎和腕管综合征的风险增加。
