Less Cancer Risk With Short-Term Immunosuppressant Use

According to new research conducted by researchers at the University of Pittsburgh and Mass Eye and Ear, a part of the Mass General Brigham health care system, short-term use of immunosuppressant medications for managing an inflammatory disease was not linked to an increased chance of later developing cancer risk. The study was published in the journal BMJ Oncology.

The results should reassure patients and doctors who might be hesitant to give the drugs because it is known that they raise cancer risk in those who take them for a lifetime or for a long period of time in order to avoid serious repercussions like organ rejection in transplant recipients.

“When we got these results, I was reassured, and I hope patients will be, too,” said lead author Jeanine Buchanich, Ph.D., associate dean for research and associate professor of biostatistics at Pitt’s School of Public Health. “Immunosuppressants are widely used and transformative for care of patients with inflammatory diseases, but the potential concern that they carry a cancer risk has forced people to make difficult decisions without enough information. Alleviating that concern with use for inflammatory diseases will help people make the treatment decision that’s right for them.”

The most recent research came from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort, which started 20 years ago when the study’s lead author, John Kempen, M.D., Ph.D., senior scientist and director of epidemiology for ophthalmology at Mass Eye and Ear and professor of ophthalmology at Harvard Medical School, approached Buchanich, who oversees Pitt Public Health’s Center for Occupational Biostatistics and Epidemiology, These immune-related eye conditions can not directly cause cancer but can be quite dangerous, with blindness as a potential consequence.

Immunosuppressive drugs are frequently used to treat the disorders, and patients typically take them for many months to several years.

This new study provides proof of the low cancer risk connected to immunosuppressive therapies that the SITE study group discovered. In an Ophthalmology study released last month, researchers found no evidence of an elevated risk of cancer-related or general death in people taking routinely prescribed immunosuppressants. 15,938 SITE participants monitored for an average of 10 years were included in the study.

10,872 individuals were enrolled in the BMJ Oncology study, which comprised 84% of the SITE participants who resided in one of the 12 states where the research team gathered information tying participants to each state’s cancer registries. Despite the fact that the majority of states keep track of cancer incidence, there is no one federal cancer registry, and different states have varied data-sharing policies and interfaces. Because of this, doing extensive epidemiological cancer studies in the United States is challenging, making our study – which combined years of data from many states – rare.

After taking immunosuppressive drugs, the research team followed every participant for an average of 10 years, or over a comparable period for those who did not take immunosuppression, to determine if they ever developed cancer. The study included patients who were taking immunosuppressants from the four categories of TNF-inhibitors, antimetabolites, alkylating drugs, and calcineurin inhibitors. Some patients were taking more than one type. Patients took the drugs for an average of one year.

No evidence of an elevated risk of cancer in individuals taking immunosuppressant drugs for a brief period of time, independent of medication dose, was discovered by researchers across all 4 classes of these drugs.

Kempen said that the results are likely generalizable to patients with inflammatory disorders, even though the study only included individuals with noninfectious eye conditions, and the researchers warn these findings cannot be applied to everyone taking immunosuppressants.

“The patients in our study actually tended to have a lower incidence of cancer than non-immunosuppressed patients, suggesting that an increased risk of overall cancer from commonly used immunosuppressants given for the short- to medium-term is very unlikely,” said Kempen. “This result is foundational for a large number of patients with inflammatory eye conditions and a broad range of patients with other inflammatory diseases.”

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