The relationship between cancer and medication exposures in systemic lupus erythaematosus: a case–cohort study
Identifieur interne : 001C00 ( Istex/Curation ); précédent : 001B99; suivant : 001C01The relationship between cancer and medication exposures in systemic lupus erythaematosus: a case–cohort study
Auteurs : S. Bernatsky [Canada] ; L. Joseph [Canada] ; J-F Boivin [Canada] ; C. Gordon [Canada] ; M. Urowitz [États-Unis] ; D. Gladman [États-Unis] ; P R Fortin [États-Unis] ; E. Ginzler [Corée du Sud] ; S-C Bae [Canada] ; S. Barr [Royaume-Uni] ; S. Edworthy [Royaume-Uni] ; D. Isenberg [États-Unis] ; A. Rahman [États-Unis] ; M. Petri [États-Unis] ; G S Alarc N [États-Unis] ; C. Aranow [États-Unis] ; M-A Dooley [Canada] ; R. Rajan [Canada] ; J-L Sénécal [Canada] ; M. Zummer [États-Unis] ; S. Manzi [États-Unis] ; R. Ramsey-Goldman [Canada, Royaume-Uni, États-Unis, Corée du Sud] ; A E Clarke [Canada]Source :
- Annals of the Rheumatic Diseases [ 0003-4967 ] ; 2008-01.
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- America cohort entry, America sjogren syndrome, American college, Arthritis, Arthritis foundation, Aspirin, Autoimmune diseases, Azathioprine, Bladder cancers, Breast cancer, Calendar year, Cancer, Cancer cases, Cancer incidence, Cancer occurrence, Cancer risk, Carcinogenic risks, Categorical variables, Centre, Cervical, Cervical dysplasia, Chapel hill, Chemotherapy effects, Clinical characteristics, Clinical epidemiology, Clinical factors, Clinical immunology, Cohort, Cohort entry, Cohort studies, Cohort study, Confirmatory tests, Cumulative disease activity, Cumulative exposure, Cumulative exposures, Cyclophosphamide, Cyclophosphamide azathioprine methotrexate agents, Cyclophosphamide exposure, Cyclophosphamide exposures, Damage index, Damage item, Damage scores, Data collection, Disease activity, Drug exposures, Erythematosus, Exploratory analyses, Exposure categories, Glucocorticoids nsaids aspirin tobacco, Haematological, Haematological cancer, Haematological cancers, Haematological malignancies, Hazard ratio, Iarc monographs, Immunosuppressive, Immunosuppressive agents, Immunosuppressive drug, Immunosuppressive drug exposure, Immunosuppressive drug exposures, Immunosuppressive drugs, Immunosuppressive therapy, Immunosuppressive treatment, Index time, International agency, International cohort study, Intravenous, Intravenous cyclophosphamide, Invasive cancers, Investigator award, Johns hopkins university, Lung cancer, Lung cancers, Lupus, Lupus cohort, Lymphoma, Lymphoma risk, Malignancy, Malignancy risk, Mcgill university health centre, Medication, Medication exposures, Methotrexate, Nsaid, Organ damage, Other medication, Overall cancer risk, Parenteral exposures, Potential confounder, Power limitations, Primary analyses, Primary exposure, Report table, Research institute, Rheum, Rheumatic diseases, Rheumatoid arthritis, Rheumatol, Rheumatology, Rheumatology damage index, Second cancers, Separate analyses, Sicca symptoms, Sjogren, Sjogren syndrome, Study entry, Syndrome, Systematic overview, Systemic, Systemic lupus, Systemic lupus erythaematosus, Systemic lupus erythematosus, Time axis, Tobacco exposure, Tumour registries, White damage1 residence.
Abstract
Objective: To examine if, in systemic lupus erythaematosus (SLE), exposure to immunosuppressive therapy (cyclophosphamide, azathioprine, methotrexate) increases cancer risk. Methods: A case–cohort study was performed within a multi-site international SLE cohort; subjects were linked to regional tumour registries to determine cancer cases occurring after entry into the cohort. We calculated the hazard ratio (HR) for cancer after exposure to an immunosuppressive drug, in models that controlled for other medications (anti-malarial drugs, systemic glucocorticoids, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin), smoking, age, sex, race/ethnicity, geographic location, calendar year, SLE duration, and lupus damage scores. In the primary analyses, exposures were treated categorically (ever/never) and as time-dependent. Results: Results are presented from 246 cancer cases and 538 controls without cancer. The adjusted HR for overall cancer risk after any immunosuppressive drug was 0.82 (95% CI 0.50–1.36). Age ⩾65, and the presence of non-malignancy damage were associated with overall cancer risk. For lung cancer (n = 35 cases), smoking was also a prominent risk factor. When looking at haematological cancers specifically (n = 46 cases), there was a suggestion of an increased risk after immunosuppressive drug exposures, particularly when these were lagged by a period of 5 years (adjusted HR 2.29, 95% CI 1.02–5.15). Conclusions: In our SLE sample, age ⩾65, damage, and tobacco exposure were associated with cancer risk. Though immunosuppressive therapy may not be the principal driving factor for overall cancer risk, it may contribute to an increased risk of haematological malignancies. Future studies are in progress to evaluate independent influence of medication exposures and disease activity on risk of malignancy.
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DOI: 10.1136/ard.2006.069039
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Joseph</name><affiliation wicri:level="1"><mods:affiliation>Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec</wicri:regionArea></affiliation></author><author><name sortKey="Boivin, J F" sort="Boivin, J F" uniqKey="Boivin J" first="J-F" last="Boivin">J-F Boivin</name><affiliation wicri:level="1"><mods:affiliation>Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec</wicri:regionArea></affiliation></author><author><name sortKey="Gordon, C" sort="Gordon, C" uniqKey="Gordon C" first="C" last="Gordon">C. 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Aranow</name><affiliation wicri:level="1"><mods:affiliation>Department of Medicine, Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, North Carolina, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, North Carolina</wicri:regionArea></affiliation></author><author><name sortKey="Dooley, M A" sort="Dooley, M A" uniqKey="Dooley M" first="M-A" last="Dooley">M-A Dooley</name><affiliation wicri:level="1"><mods:affiliation>Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Oncology, McGill University Health Centre, Montreal, Quebec</wicri:regionArea></affiliation></author><author><name sortKey="Rajan, R" sort="Rajan, R" uniqKey="Rajan R" first="R" last="Rajan">R. 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Zummer</name><affiliation wicri:level="1"><mods:affiliation>Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania</wicri:regionArea></affiliation></author><author><name sortKey="Manzi, S" sort="Manzi, S" uniqKey="Manzi S" first="S" last="Manzi">S. Manzi</name><affiliation wicri:level="1"><mods:affiliation>Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois</wicri:regionArea></affiliation></author><author><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><affiliation wicri:level="1"><mods:affiliation>1 Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>1 Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>2 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>2 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>3 Department of Rheumatology, University of Birmingham, UK</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>3 Department of Rheumatology, University of Birmingham</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>4 Division of Health Care & Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>4 Division of Health Care & Outcomes Research, Toronto Western Research Institute, Toronto, Ontario</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>5 Division of Rheumatology, Department of Medicine, SUNY Health Science Center at Brooklyn, New York, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>5 Division of Rheumatology, Department of Medicine, SUNY Health Science Center at Brooklyn, New York</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>6 Department of Internal Medicine, Division of Rheumatology, Hanyang University College of Medicine and the Hospital of Rheumatic Diseases, Seoul, Korea</mods:affiliation><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>6 Department of Internal Medicine, Division of Rheumatology, Hanyang University College of Medicine and the Hospital of Rheumatic Diseases, Seoul</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>7 Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>7 Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>8 Centre for Rheumatology Research - Department of Medicine, University College London, UK</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>8 Centre for Rheumatology Research - Department of Medicine, University College London</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>9 Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>9 Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>10 Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama, Birmingham, Alabama, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>10 Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama, Birmingham, Alabama</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>11 Department of Medicine, Columbia University, New York, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>11 Department of Medicine, Columbia University, New York</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>12 Department of Medicine, Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, North Carolina, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>12 Department of Medicine, Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, North Carolina</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>13 Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>13 Department of Oncology, McGill University Health Centre, Montreal, Quebec</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>14 Division of Rheumatology, Centre Hospitalier de l’Universite de Montreal, Department of Medicine, University of Montreal School of Medicine, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>14 Division of Rheumatology, Centre Hospitalier de l’Universite de Montreal, Department of Medicine, University of Montreal School of Medicine, Montreal, Quebec</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>15 Department of Rheumatology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>15 Department of Rheumatology, Maisonneuve-Rosemont Hospital, Montreal, Quebec</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>16 Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>16 Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>17 Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>17 Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois</wicri:regionArea></affiliation></author><author><name sortKey="Clarke, A E" sort="Clarke, A E" uniqKey="Clarke A" first="A E" last="Clarke">A E Clarke</name><affiliation wicri:level="1"><mods:affiliation>Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:A4ED4E047016C31087BDE29E164614EA04E5C400</idno><date when="2008" year="2008">2008</date><idno type="doi">10.1136/ard.2006.069039</idno><idno type="url">https://api.istex.fr/ark:/67375/NVC-KQHFPBGL-7/fulltext.pdf</idno><idno type="wicri:Area/Istex/Corpus">001C00</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001C00</idno><idno type="wicri:Area/Istex/Curation">001C00</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">The relationship between cancer and medication exposures in systemic lupus erythaematosus: a case–cohort study</title><author><name sortKey="Bernatsky, S" sort="Bernatsky, S" uniqKey="Bernatsky S" first="S" last="Bernatsky">S. Bernatsky</name><affiliation wicri:level="1"><mods:affiliation>Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec</wicri:regionArea></affiliation></author><author><name sortKey="Joseph, L" sort="Joseph, L" uniqKey="Joseph L" first="L" last="Joseph">L. Joseph</name><affiliation wicri:level="1"><mods:affiliation>Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec</wicri:regionArea></affiliation></author><author><name sortKey="Boivin, J F" sort="Boivin, J F" uniqKey="Boivin J" first="J-F" last="Boivin">J-F Boivin</name><affiliation wicri:level="1"><mods:affiliation>Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec</wicri:regionArea></affiliation></author><author><name sortKey="Gordon, C" sort="Gordon, C" uniqKey="Gordon C" first="C" last="Gordon">C. Gordon</name><affiliation wicri:level="1"><mods:affiliation>Division of Health Care & Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Division of Health Care & Outcomes Research, Toronto Western Research Institute, Toronto, Ontario</wicri:regionArea></affiliation></author><author><name sortKey="Urowitz, M" sort="Urowitz, M" uniqKey="Urowitz M" first="M" last="Urowitz">M. Urowitz</name><affiliation wicri:level="1"><mods:affiliation>Division of Rheumatology, Department of Medicine, SUNY Health Science Center at Brooklyn, New York, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology, Department of Medicine, SUNY Health Science Center at Brooklyn, New York</wicri:regionArea></affiliation></author><author><name sortKey="Gladman, D" sort="Gladman, D" uniqKey="Gladman D" first="D" last="Gladman">D. Gladman</name><affiliation wicri:level="1"><mods:affiliation>Division of Rheumatology, Department of Medicine, SUNY Health Science Center at Brooklyn, New York, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology, Department of Medicine, SUNY Health Science Center at Brooklyn, New York</wicri:regionArea></affiliation></author><author><name sortKey="Fortin, P R" sort="Fortin, P R" uniqKey="Fortin P" first="P R" last="Fortin">P R Fortin</name><affiliation wicri:level="1"><mods:affiliation>Division of Rheumatology, Department of Medicine, SUNY Health Science Center at Brooklyn, New York, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology, Department of Medicine, SUNY Health Science Center at Brooklyn, New York</wicri:regionArea></affiliation></author><author><name sortKey="Ginzler, E" sort="Ginzler, E" uniqKey="Ginzler E" first="E" last="Ginzler">E. Ginzler</name><affiliation wicri:level="1"><mods:affiliation>Department of Internal Medicine, Division of Rheumatology, Hanyang University College of Medicine and the Hospital of Rheumatic Diseases, Seoul, Korea</mods:affiliation><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>Department of Internal Medicine, Division of Rheumatology, Hanyang University College of Medicine and the Hospital of Rheumatic Diseases, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Bae, S C" sort="Bae, S C" uniqKey="Bae S" first="S-C" last="Bae">S-C Bae</name><affiliation wicri:level="1"><mods:affiliation>Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta</wicri:regionArea></affiliation></author><author><name sortKey="Barr, S" sort="Barr, S" uniqKey="Barr S" first="S" last="Barr">S. Barr</name><affiliation wicri:level="1"><mods:affiliation>Centre for Rheumatology Research - Department of Medicine, University College London, UK</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Rheumatology Research - Department of Medicine, University College London</wicri:regionArea></affiliation></author><author><name sortKey="Edworthy, S" sort="Edworthy, S" uniqKey="Edworthy S" first="S" last="Edworthy">S. Edworthy</name><affiliation wicri:level="1"><mods:affiliation>Centre for Rheumatology Research - Department of Medicine, University College London, UK</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Rheumatology Research - Department of Medicine, University College London</wicri:regionArea></affiliation></author><author><name sortKey="Isenberg, D" sort="Isenberg, D" uniqKey="Isenberg D" first="D" last="Isenberg">D. Isenberg</name><affiliation wicri:level="1"><mods:affiliation>Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland</wicri:regionArea></affiliation></author><author><name sortKey="Rahman, A" sort="Rahman, A" uniqKey="Rahman A" first="A" last="Rahman">A. Rahman</name><affiliation wicri:level="1"><mods:affiliation>Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland</wicri:regionArea></affiliation></author><author><name sortKey="Petri, M" sort="Petri, M" uniqKey="Petri M" first="M" last="Petri">M. Petri</name><affiliation wicri:level="1"><mods:affiliation>Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama, Birmingham, Alabama, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama, Birmingham, Alabama</wicri:regionArea></affiliation></author><author><name sortKey="Alarc N, G S" sort="Alarc N, G S" uniqKey="Alarc N G" first="G S" last="Alarc N">G S Alarc N</name><affiliation wicri:level="1"><mods:affiliation>Department of Medicine, Columbia University, New York, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, Columbia University, New York</wicri:regionArea></affiliation></author><author><name sortKey="Aranow, C" sort="Aranow, C" uniqKey="Aranow C" first="C" last="Aranow">C. Aranow</name><affiliation wicri:level="1"><mods:affiliation>Department of Medicine, Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, North Carolina, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, North Carolina</wicri:regionArea></affiliation></author><author><name sortKey="Dooley, M A" sort="Dooley, M A" uniqKey="Dooley M" first="M-A" last="Dooley">M-A Dooley</name><affiliation wicri:level="1"><mods:affiliation>Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Oncology, McGill University Health Centre, Montreal, Quebec</wicri:regionArea></affiliation></author><author><name sortKey="Rajan, R" sort="Rajan, R" uniqKey="Rajan R" first="R" last="Rajan">R. Rajan</name><affiliation wicri:level="1"><mods:affiliation>Division of Rheumatology, Centre Hospitalier de l’Universite de Montreal, Department of Medicine, University of Montreal School of Medicine, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Division of Rheumatology, Centre Hospitalier de l’Universite de Montreal, Department of Medicine, University of Montreal School of Medicine, Montreal, Quebec</wicri:regionArea></affiliation></author><author><name sortKey="Senecal, J L" sort="Senecal, J L" uniqKey="Senecal J" first="J-L" last="Sénécal">J-L Sénécal</name><affiliation wicri:level="1"><mods:affiliation>Department of Rheumatology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Rheumatology, Maisonneuve-Rosemont Hospital, Montreal, Quebec</wicri:regionArea></affiliation></author><author><name sortKey="Zummer, M" sort="Zummer, M" uniqKey="Zummer M" first="M" last="Zummer">M. Zummer</name><affiliation wicri:level="1"><mods:affiliation>Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania</wicri:regionArea></affiliation></author><author><name sortKey="Manzi, S" sort="Manzi, S" uniqKey="Manzi S" first="S" last="Manzi">S. Manzi</name><affiliation wicri:level="1"><mods:affiliation>Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois</wicri:regionArea></affiliation></author><author><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><affiliation wicri:level="1"><mods:affiliation>1 Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>1 Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>2 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>2 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>3 Department of Rheumatology, University of Birmingham, UK</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>3 Department of Rheumatology, University of Birmingham</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>4 Division of Health Care & Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>4 Division of Health Care & Outcomes Research, Toronto Western Research Institute, Toronto, Ontario</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>5 Division of Rheumatology, Department of Medicine, SUNY Health Science Center at Brooklyn, New York, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>5 Division of Rheumatology, Department of Medicine, SUNY Health Science Center at Brooklyn, New York</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>6 Department of Internal Medicine, Division of Rheumatology, Hanyang University College of Medicine and the Hospital of Rheumatic Diseases, Seoul, Korea</mods:affiliation><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>6 Department of Internal Medicine, Division of Rheumatology, Hanyang University College of Medicine and the Hospital of Rheumatic Diseases, Seoul</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>7 Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>7 Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>8 Centre for Rheumatology Research - Department of Medicine, University College London, UK</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>8 Centre for Rheumatology Research - Department of Medicine, University College London</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>9 Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>9 Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>10 Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama, Birmingham, Alabama, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>10 Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama, Birmingham, Alabama</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>11 Department of Medicine, Columbia University, New York, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>11 Department of Medicine, Columbia University, New York</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>12 Department of Medicine, Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, North Carolina, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>12 Department of Medicine, Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, North Carolina</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>13 Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>13 Department of Oncology, McGill University Health Centre, Montreal, Quebec</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>14 Division of Rheumatology, Centre Hospitalier de l’Universite de Montreal, Department of Medicine, University of Montreal School of Medicine, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>14 Division of Rheumatology, Centre Hospitalier de l’Universite de Montreal, Department of Medicine, University of Montreal School of Medicine, Montreal, Quebec</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>15 Department of Rheumatology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>15 Department of Rheumatology, Maisonneuve-Rosemont Hospital, Montreal, Quebec</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>16 Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>16 Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>17 Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>17 Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois</wicri:regionArea></affiliation></author><author><name sortKey="Clarke, A E" sort="Clarke, A E" uniqKey="Clarke A" first="A E" last="Clarke">A E Clarke</name><affiliation wicri:level="1"><mods:affiliation>Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec</wicri:regionArea></affiliation></author></analytic><monogr></monogr><series><title level="j">Annals of the Rheumatic Diseases</title><title level="j" type="abbrev">Ann Rheum Dis</title><idno type="ISSN">0003-4967</idno><idno type="eISSN">1468-2060</idno><imprint><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><date type="published" when="2008-01">2008-01</date><biblScope unit="volume">67</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="74">74</biblScope></imprint><idno type="ISSN">0003-4967</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0003-4967</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>America cohort entry</term><term>America sjogren syndrome</term><term>American college</term><term>Arthritis</term><term>Arthritis foundation</term><term>Aspirin</term><term>Autoimmune diseases</term><term>Azathioprine</term><term>Bladder cancers</term><term>Breast cancer</term><term>Calendar year</term><term>Cancer</term><term>Cancer cases</term><term>Cancer incidence</term><term>Cancer occurrence</term><term>Cancer risk</term><term>Carcinogenic risks</term><term>Categorical variables</term><term>Centre</term><term>Cervical</term><term>Cervical dysplasia</term><term>Chapel hill</term><term>Chemotherapy effects</term><term>Clinical characteristics</term><term>Clinical epidemiology</term><term>Clinical factors</term><term>Clinical immunology</term><term>Cohort</term><term>Cohort entry</term><term>Cohort studies</term><term>Cohort study</term><term>Confirmatory tests</term><term>Cumulative disease activity</term><term>Cumulative exposure</term><term>Cumulative exposures</term><term>Cyclophosphamide</term><term>Cyclophosphamide azathioprine methotrexate agents</term><term>Cyclophosphamide exposure</term><term>Cyclophosphamide exposures</term><term>Damage index</term><term>Damage item</term><term>Damage scores</term><term>Data collection</term><term>Disease activity</term><term>Drug exposures</term><term>Erythematosus</term><term>Exploratory analyses</term><term>Exposure categories</term><term>Glucocorticoids nsaids aspirin tobacco</term><term>Haematological</term><term>Haematological cancer</term><term>Haematological cancers</term><term>Haematological malignancies</term><term>Hazard ratio</term><term>Iarc monographs</term><term>Immunosuppressive</term><term>Immunosuppressive agents</term><term>Immunosuppressive drug</term><term>Immunosuppressive drug exposure</term><term>Immunosuppressive drug exposures</term><term>Immunosuppressive drugs</term><term>Immunosuppressive therapy</term><term>Immunosuppressive treatment</term><term>Index time</term><term>International agency</term><term>International cohort study</term><term>Intravenous</term><term>Intravenous cyclophosphamide</term><term>Invasive cancers</term><term>Investigator award</term><term>Johns hopkins university</term><term>Lung cancer</term><term>Lung cancers</term><term>Lupus</term><term>Lupus cohort</term><term>Lymphoma</term><term>Lymphoma risk</term><term>Malignancy</term><term>Malignancy risk</term><term>Mcgill university health centre</term><term>Medication</term><term>Medication exposures</term><term>Methotrexate</term><term>Nsaid</term><term>Organ damage</term><term>Other medication</term><term>Overall cancer risk</term><term>Parenteral exposures</term><term>Potential confounder</term><term>Power limitations</term><term>Primary analyses</term><term>Primary exposure</term><term>Report table</term><term>Research institute</term><term>Rheum</term><term>Rheumatic diseases</term><term>Rheumatoid arthritis</term><term>Rheumatol</term><term>Rheumatology</term><term>Rheumatology damage index</term><term>Second cancers</term><term>Separate analyses</term><term>Sicca symptoms</term><term>Sjogren</term><term>Sjogren syndrome</term><term>Study entry</term><term>Syndrome</term><term>Systematic overview</term><term>Systemic</term><term>Systemic lupus</term><term>Systemic lupus erythaematosus</term><term>Systemic lupus erythematosus</term><term>Time axis</term><term>Tobacco exposure</term><term>Tumour registries</term><term>White damage1 residence</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objective: To examine if, in systemic lupus erythaematosus (SLE), exposure to immunosuppressive therapy (cyclophosphamide, azathioprine, methotrexate) increases cancer risk. Methods: A case–cohort study was performed within a multi-site international SLE cohort; subjects were linked to regional tumour registries to determine cancer cases occurring after entry into the cohort. We calculated the hazard ratio (HR) for cancer after exposure to an immunosuppressive drug, in models that controlled for other medications (anti-malarial drugs, systemic glucocorticoids, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin), smoking, age, sex, race/ethnicity, geographic location, calendar year, SLE duration, and lupus damage scores. In the primary analyses, exposures were treated categorically (ever/never) and as time-dependent. Results: Results are presented from 246 cancer cases and 538 controls without cancer. The adjusted HR for overall cancer risk after any immunosuppressive drug was 0.82 (95% CI 0.50–1.36). Age ⩾65, and the presence of non-malignancy damage were associated with overall cancer risk. For lung cancer (n = 35 cases), smoking was also a prominent risk factor. When looking at haematological cancers specifically (n = 46 cases), there was a suggestion of an increased risk after immunosuppressive drug exposures, particularly when these were lagged by a period of 5 years (adjusted HR 2.29, 95% CI 1.02–5.15). Conclusions: In our SLE sample, age ⩾65, damage, and tobacco exposure were associated with cancer risk. Though immunosuppressive therapy may not be the principal driving factor for overall cancer risk, it may contribute to an increased risk of haematological malignancies. Future studies are in progress to evaluate independent influence of medication exposures and disease activity on risk of malignancy.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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