Cumulative immunosuppressant exposure is associated with diversified cancer risk among 14 832 patients with systemic lupus erythematosus: a nested case–control study

Abstract

Diverse cancer risks are associated with different immunosuppressants in patients with SLE. CYC increases the risk of cancer, and HCQ decreases this risk in SLE patients, both in a dose-dependent manner.

The relationship between cancer and medication exposure in patients with systemic lupus erythematosus: a nested case-control study

“…A protective function of antimalarial against cancer in SLE patients has been proposed [38]. Hsu et al found that HCQ decreased cancer risk in a dose-dependent manner [21]. Our current large-scale study has also elucidated a negative association between HCQ and cancer.…”

“…A different research reported that exposure to CTX might contribute to a higher lymphoma risk in SLE patients [19], although this was contradicted by a different report showing that the use of CTX and AZA did not contribute to lymphoma risk [20]. It has been demonstrated that CTX increases cancer risk in SLE patients in a dose-dependent manner [21]. Therefore, more investigations looking at a larger number of participants is needed.…”

“…The mechanism remains unclear, it is speculated that various factors including medication exposure, the activated auto-immune system, viral infection, overlap syndrome, as well as traditional lifestyle cancer risk factors may all contribute to the increased cancer risk in SLE [24,25]. To the best of our knowledge, only a handful of studies have been done to explore the association between cancer and the drugs used in SLE, and the results were inconsistent [18][19][20][21]. In this large nested case-control study, we found that the SLE patients with cancer had lower disease activity, and that HCQ was negatively associated with cancer risk in SLE patients.…”

“…Another study demonstrated that although immunosuppressant including CTX, AZA and MTX were not associated with overall cancer risk, they may increase the risk of hematological malignancies in patients with SLE [18]. It has been reported that CTX administration is associated with increased cancer risk while administration of HCQ is thought to lower cancer risk [21].…”

Systemic lupus erythematosus complicated with gastric cancer in an old man: A case report and literature review

“…The relation between SLE and GC has not been fully elucidated; the mechanism may be as follows: (a) Patients with SLE have an increased risk of developing tumors, possibly related to the disease itself . Literature reports also showed the development of tumor was related to the use of immunosuppressive agents, especially cyclophosphamide . (b) Tumors trigger immune abnormalities presented with varieties of rheumatoid lesions, including inflammatory myopathy, arthritis, vasculitis and SLE .…”