School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.
Department of Pharmacy, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Am J Clin Dermatol. 2023 Sep;24(5):799-808. doi: 10.1007/s40257-023-00787-3. Epub 2023 Jun 6.
The cancer risks associated with treatment with topical calcineurin inhibitors (TCIs) in patients with atopic dermatitis (AD) remain controversial, and limited evidence exists regarding the cancer risks among patients with AD treated with TCIs in Asian populations.
This study identified the association between TCI use and the risks of developing all cancers, lymphoma, skin cancers, and other cancers.
This study was a nationwide, population-based, retrospective cohort study.
Taiwan's National Health Insurance Research Database.
Patients diagnosed at least twice with ICD-9 code 691 or at least one time with ICD-9 codes 691 or 692.9 within 1 year between 1 January 2003 and 31 December 2010 were included and followed until 31 December 2018. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using the Cox proportional hazard ratio model.
Patients using tacrolimus or pimecrolimus were identified in the National Health Insurance Research Database and compared with patients using topical corticosteroids (TCSs).
The main outcomes were hazard ratios (HRs) of cancer diagnoses and associated outcomes obtained from the Taiwan Cancer Registry database.
After propensity score (PS) matching, the final cohort included 195,925 patients with AD, including 39,185 who were initial TCI users and 156,740 who were TCS users. Propensity score matching was performed according to age, sex, index year, and Charlson Comorbidity Index using a ratio of 1:4. Except for leukemia, HR and 95% CI showed no significant associations between TCI use and the risk of developing all cancer, lymphoma, skin cancers, and other cancers. Sensitivity analysis showed that the lag time HRs for every cancer subtype continued to show no significant association between TCI use and cancer risk, except for leukemia.
Our study found no evidence to support an association between TCI use and the risks of almost all cancers compared with TCS use in patients with AD, but physicians should be aware of potentially higher risks of leukemia with TCI use. This study represents the first population-based study focused on the cancer risk of TCI use among patients with AD in an Asian population.
特应性皮炎（AD）患者使用局部钙调磷酸酶抑制剂（TCIs）治疗与癌症风险相关，仍存在争议，并且在亚洲人群中，AD 患者使用 TCIs 治疗的癌症风险的相关证据有限。
本研究旨在确定 TCI 使用与所有癌症、淋巴瘤、皮肤癌和其他癌症风险之间的关联。
这是一项全国性的、基于人群的回顾性队列研究。
台湾全民健康保险研究数据库。
在 2003 年 1 月 1 日至 2010 年 12 月 31 日期间，在一年内至少两次被诊断为 ICD-9 代码 691 或至少一次被诊断为 ICD-9 代码 691 或 692.9 的患者被纳入研究，并随访至 2018 年 12 月 31 日。使用 Cox 比例风险比模型估计危险比（HR）和 95%置信区间（CI）。
在国家健康保险研究数据库中识别出使用他克莫司或吡美莫司的患者，并与使用局部皮质类固醇（TCSs）的患者进行比较。
主要结局是从台湾癌症登记数据库获得的癌症诊断和相关结局的危险比（HRs）。
在进行倾向评分（PS）匹配后，最终队列纳入了 195925 例 AD 患者，其中 39185 例为初始 TCI 使用者，156740 例为 TCS 使用者。根据年龄、性别、索引年度和 Charlson 合并症指数，采用 1:4 的比例进行 PS 匹配。除白血病外，HR 和 95%CI 显示 TCI 使用与所有癌症、淋巴瘤、皮肤癌和其他癌症风险之间无显著关联。敏感性分析显示，每种癌症亚型的滞后时间 HR 继续显示 TCI 使用与癌症风险之间无显著关联，除了白血病。
本研究未发现 TCI 使用与 AD 患者 TCS 使用相比，与几乎所有癌症风险相关的证据，但医生应注意 TCI 使用可能导致白血病风险增加。本研究代表了首次在亚洲人群中针对 AD 患者 TCI 使用的癌症风险进行的基于人群的研究。
