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Fusano M, Soglia S, Franceschini F, Cavazzana I, Fredi M, Tomasi C, Calzavara-Pinton I, Arisi M, Licata G, Mezzana S, Rossi M, Venturini M, Calzavara-Pinton P. Evaluation of the incidence of melanoma and non-melanoma skin cancer in patients with systemic lupus erythematosus and systemic sclerosis. Ital J Dermatol Venerol 2024; 159:436-443. [PMID: 39069842 DOI: 10.23736/s2784-8671.24.07763-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
BACKGROUND The incidence of skin cancer in patients with systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) has only been investigated with retrospective studies enrolling a low number of patients. The aims of our study were to assess the incidence of skin cancer in two large cohorts of patients, one with SLE and the other with SSc and investigating possible risk factors. METHODS Ninety SLE, 53 SSc patients and 392 control subjects were enrolled. A questionnaire including personal and medical details was fulfilled. The severity of photoaging, photosensitivity and sun exposure habits was assessed. Skin lesions were evaluated using a video-dermatoscope. Suspicious lesions were surgically removed. RESULTS The incidence of skin cancer was not different to those of controls. However, a decrease in the incidence of basal cell carcinoma was found in patients with SLE. This finding associated negatively with photosensitivity. SSc patients with skin malignancies did not report photosensitivity and did not adopt a careful photoprotection. A positive association was found between skin cancer and diffuse cutaneous sclerosis, pitting scars, severe photoaging and treatment with Iloprost. CONCLUSIONS Regular avoidance of sun exposure and photoprotection are effective in reducing the development of skin cancer in patients with autoimmune diseases.
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Affiliation(s)
- Marta Fusano
- Department of Dermatology, University of Brescia and ASST-Spedali Civili, Brescia, Italy
| | - Simone Soglia
- Department of Dermatology, University of Brescia and ASST-Spedali Civili, Brescia, Italy
| | - Franco Franceschini
- Department of Rheumatology, University of Brescia and ASST-Spedali Civili, Brescia, Italy
| | - Ilaria Cavazzana
- Department of Rheumatology, University of Brescia and ASST-Spedali Civili, Brescia, Italy
| | - Micaela Fredi
- Department of Rheumatology, University of Brescia and ASST-Spedali Civili, Brescia, Italy
| | - Cesare Tomasi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Irene Calzavara-Pinton
- Department of Dermatology, University of Brescia and ASST-Spedali Civili, Brescia, Italy
| | - Mariachiara Arisi
- Department of Dermatology, University of Brescia and ASST-Spedali Civili, Brescia, Italy -
| | - Gaetano Licata
- Department of Dermatology, University of Brescia and ASST-Spedali Civili, Brescia, Italy
| | - Sara Mezzana
- Department of Dermatology, University of Brescia and ASST-Spedali Civili, Brescia, Italy
| | - Mariateresa Rossi
- Department of Dermatology, University of Brescia and ASST-Spedali Civili, Brescia, Italy
| | - Marina Venturini
- Department of Dermatology, University of Brescia and ASST-Spedali Civili, Brescia, Italy
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Seror R, Lafourcade A, De Rycke Y, Pinto S, Castaneda J, Fautrel B, Mariette X, Tubach F. Risk of malignancy in rheumatoid arthritis patients initiating biologics: an historical propensity score matched cohort study within the French nationwide healthcare database. RMD Open 2022; 8:rmdopen-2021-002139. [PMID: 35738803 PMCID: PMC9226991 DOI: 10.1136/rmdopen-2021-002139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/22/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the risk of malignancy between patients with rheumatoid arthritis (RA) initiating their first biological disease-modifying antirheumatic drug (bDMARD) and those continuing conventional synthetic DMARDs (csDMARDs). Methods Nine-year historical Propensity Score (PS) matched cohort study within the French national healthcare database (87% of the French population; ~57 million people), including adults RA without malignancy. Exposures started with the first use of any systemic treatment (csDMARDs and/or bDMARDs). Incident users of bDMARDs were matched on a dynamic PS to patients continuing csDMARDs. Their risk of malignancy was compared by Cox model. Results From 1 January 2007 to 31 December 2014, 83 706 patients with RA started their first systemic treatment (63 837 remained on csDMARDs and 19 869 initiated a bDMARD during follow-up). After dynamic PS matching, 19 727 bDMARD initiators were compared with 19 727 RA remaining on csDMARDs. They did not statistically differ in risk of overall malignancies (HR 0.99 (95% CI 0.86 to 1.14)), solid cancer (HR 0.95 (95% CI 0.82 to 1.11)), nor lymphoma (HR 1.35 (95% CI 0.72 to 2.53)). Results were similar when bDMARDs were given as monotherapy or in association with csDMARDs. Analyses restricted to patients starting TNF inhibitor as first bDMARD compared with matched RA remaining on csDMARDs, provided similar results (HR for overall malignancy 1.03 (95% CI 0.88 to 1.21)). Sensitivity analyses, varying carry-over periods (up to 5 years) to define risk periods, provided similar results. Conclusions In this historical cohort study within the French nationwide healthcare database, the risk of overall, solid or haematological malignancies did not significantly differ between patients with RA initiating bDMARD and those continuing csDMARDs.
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Affiliation(s)
- Raphaele Seror
- Service de Rhumatologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Université Paris-Saclay, FHU CARE, Le Kremlin-Bicetre, France .,INSERM UMR 1184, Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicetre, France
| | - Alexandre Lafourcade
- Centre de Pharmacoépidémiologie (Cephepi), AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Yann De Rycke
- Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, Sorbonne Université, Faculté de médecine Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,Institut Pierre Louis d'epidemiologie, Sorbonne University, INSERM UMR-S 1136, Paris, France
| | - Sandrine Pinto
- Institut Pierre Louis d'epidemiologie, Sorbonne University, INSERM UMR-S 1136, Paris, France
| | - Johann Castaneda
- Centre de Pharmacoépidémiologie (Cephepi), AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Bruno Fautrel
- Institut Pierre Louis d'epidemiologie, Sorbonne University, INSERM UMR-S 1136, Paris, France.,Service de Rhumatologie, Sorbonne Université, AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
| | - Xavier Mariette
- Service de Rhumatologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Université Paris-Saclay, FHU CARE, Le Kremlin-Bicetre, France.,INSERM UMR 1184, Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicetre, France
| | - Florence Tubach
- Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, Sorbonne Université, Faculté de médecine Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,Institut Pierre Louis d'epidemiologie, Sorbonne University, INSERM UMR-S 1136, Paris, France.,delete this affiliaton, Paris, France
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