Papaliodis George N, Yu Yinxi, Brill Daniel A, Sobrin Lucia, VanderBeek Brian
From the Massachusetts Eye and Ear Infirmary/Harvard Medical School, Ocular Immunology and Uveitis Service (G.N.P., L.S.), Boston, Massachusetts, USA.
Scheie Eye Institute, University of Pennsylvania (Y.Y., B.V.), Philadelphia, Pennsylvania, USA.
Am J Ophthalmol. 2024 Sep;265:241-247. doi: 10.1016/j.ajo.2024.04.015. Epub 2024 Apr 26.
Patients with noninfectious uveitis (NIU) can require treatment with systemic immunomodulatory therapy (IMT), but it is unclear whether IMT drug categories increase the risk of malignancy in NIU patients. The purpose of this study is to determine if the use of systemic IMT in patients with NIU is associated with an increased risk of malignancy.
Clinical cohort study.
Patients were identified from a US administrative medical claims database including some Medicare Advantage and commercial plans, from 2000 to 2022. About 318,498 NIU patients were identified. Enrollees were included in the analysis if they met the following criteria: continuous enrollment in the plan for at least 1 year, and at least 2 consecutive visit diagnoses of any type of NIU, after initiation of systemic IMT. We compared the rates of incident malignancy in NIU patients treated with IMT versus the rates among NIU patients not treated with IMT. Multivariable Cox regression models were used to predict the hazard of developing incident cancer.
Of the 318,498 patients with NIU identified over a 15-year period, 318,006 did not develop malignancy, and 492 did develop malignancy. Of the patients that developed a malignancy, 280 (57%) were treated with systemic corticosteroids; 204 (41%) were treated with antimetabolites; 44 (9%) were treated with T cell inhibitors; 108 (22%) were treated with TNF alpha inhibitors; 2 (0.004%) were treated with interleukin-6 (IL-6) inhibitors; and 1 was treated with CD-20 antibodies. There were no malignancies reported in the group treated with alkylating agents. There was no association between any of the drug classes and incidence of malignancy.
This study suggests that there is no increased risk of malignancy associated with the use of systemic IMT for patients with NIU.
非感染性葡萄膜炎（NIU）患者可能需要接受全身免疫调节治疗（IMT），但尚不清楚IMT药物类别是否会增加NIU患者发生恶性肿瘤的风险。本研究的目的是确定NIU患者使用全身IMT是否与恶性肿瘤风险增加相关。
临床队列研究。
从2000年至2022年的美国行政医疗索赔数据库中识别患者，该数据库包括一些医疗保险优势计划和商业计划。共识别出约318498例NIU患者。如果入组者符合以下标准，则纳入分析：在计划中连续参保至少1年，并且在开始全身IMT后至少有2次连续就诊诊断为任何类型的NIU。我们比较了接受IMT治疗的NIU患者与未接受IMT治疗的NIU患者的新发恶性肿瘤发生率。使用多变量Cox回归模型预测发生新发癌症的风险。
在15年期间识别出的318498例NIU患者中，318006例未发生恶性肿瘤，492例发生了恶性肿瘤。在发生恶性肿瘤的患者中，280例（57%）接受了全身糖皮质激素治疗；204例（41%）接受了抗代谢药物治疗；44例（9%）接受了T细胞抑制剂治疗；108例（22%）接受了肿瘤坏死因子α抑制剂治疗；2例（0.004%）接受了白细胞介素-6（IL-6）抑制剂治疗；1例接受了CD-20抗体治疗。接受烷化剂治疗的组中未报告有恶性肿瘤。任何药物类别与恶性肿瘤发生率之间均无关联。
本研究表明，NIU患者使用全身IMT不会增加恶性肿瘤风险。
