Healio
Healio
October 28, 2015
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Methotrexate use linked to higher risk for second nonmelanoma skin cancer

The use of methotrexate, particularly in concurrence with other medications, may increase the risk for a second occurrence of nonmelanoma skin cancer for patients with rheumatoid arthritis, according to a recently published study.

A cohort of 9,460 patients with either rheumatoid arthritis (RA) or inflammatory bowel disease (IBD) was retrospectively studied from Medicare data recorded between Jan. 1, 2006 and Dec. 31, 2012. Researchers identified 6,672 patients with RA, 2,619 patients with IBD and 169 patients with both RA and IBD who had a record of nonmelanoma skin cancer (NMSC) and were followed until a second occurrence of NMSC, death, loss of medical benefits or the end of the data collection period. Patients were excluded in the presence of malignancy, organ transplant, HIV, xeroderma pigmentosa, albinism or a history of medication use associated with an increased incidence of NMSC, including cyclosporine, imiquimod or tacrolimus.

A second NMSC developed in 1,291 patients, including 910 with RA, 359 with IBD and 22 patients with both RA and IBD. The incidence rate of a second occurrence of NMSC was 58.2 per 1,000 person-years among patients with RA and 58.9 per 1,000 person years among patients with IBD, and men were more likely than women to develop a second NMSC in either group.

No association was seen between the development of a second NMSC and latitude, but a higher incidence of actinic keratosis was seen in the history of patients who developed a second NMSC.

Adjustments for age, sex, use of other immunosuppressive agents and latitude revealed longer methotrexate exposure was associated with an increased risk for developing a second NMSC with an HR of 1.10 after the first year to 1.36 between 2 and 3 years and 1.59 for over 3 years of exposure.

No association was seen between the development of NMSC and the use of Orencia (abatacept, Bristol-Meyers Squibb) or Rituxan (rituximab, Genentech/Biogen Idec) in patients with RA. Patients with IBD exposed to thiopurine or anti-tumor necrosis factor- inhibitors were not at higher risk for developing NMSC. – by Shirley Pulawski

Disclosure: Scott reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

Sources/Disclosures

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Source:

Scott FI, et al. JAMA Dermatol. 2015;doi:10.1001/jamadermatol.2015.3029.