Abstract | PURPOSE: To critically assess potentially carcinogenic effects of immunosuppressive therapy in the ocular inflammation setting. DESIGN: Focused evidence assessment. METHODS: Relevant publications were identified by MEDLINE and EMBASE queries and reference list searches. RESULTS: Extrapolation from transplant, rheumatology, skin disease, and inflammatory bowel disease cohorts to the ocular inflammation setting suggest that: 1) alkylating agents increase hematologic malignancy risk and cyclophosphamide increases bladder cancer risk, but less so with < or =18 months' duration of therapy and hydration, respectively; 2) calcineurin inhibitors and azathioprine probably do not increase total cancer risk to a detectable degree, except perhaps some other risk factors (uncommon in ocular inflammation patients) might interact with the former to raise risk; 3) tumor necrosis factor ( TNF) inhibitors may accelerate diagnosis of cancer in the first six to 12 months, but probably do not increase long-term cancer risk; and 4) changes in risk with methotrexate, mycophenolate mofetil, and daclizumab appear negligible, although nontransplant data are limited for the latter agents. Immunosuppression in general may increase skin cancer risk in a sun exposure-dependent manner. CONCLUSION:
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Authors | John H Kempen, Sapna Gangaputra, Ebenezer Daniel, Grace A Levy-Clarke, Robert B Nussenblatt, James T Rosenbaum, Eric B Suhler, Jennifer E Thorne, C Stephen Foster, Douglas A Jabs, Kathy J Helzlsouer |
Journal | American journal of ophthalmology
(Am J Ophthalmol)
Vol. 146
Issue 6
Pg. 802-12.e1
(Dec 2008)
ISSN: 1879-1891 [Electronic] United States |
PMID | 18579112
(Publication Type: Evaluation Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antibodies, Monoclonal
- Antibodies, Monoclonal, Humanized
- Antimetabolites
- Immunoglobulin G
- Immunosuppressive Agents
- Tumor Necrosis Factor-alpha
- Daclizumab
- Mycophenolic Acid
- Azathioprine
- Methotrexate
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Topics |
- Antibodies, Monoclonal
(adverse effects)
- Antibodies, Monoclonal, Humanized
- Antimetabolites
(adverse effects)
- Azathioprine
(adverse effects)
- Daclizumab
- Databases, Factual
- Humans
- Immunoglobulin G
(adverse effects)
- Immunosuppressive Agents
(adverse effects)
- Inflammation
(drug therapy)
- Longitudinal Studies
- Methotrexate
(adverse effects)
- Mycophenolic Acid
(adverse effects, analogs & derivatives)
- Neoplasms
(chemically induced)
- Risk Factors
- Tumor Necrosis Factor-alpha
(antagonists & inhibitors)
- Uveitis
(drug therapy)
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