eprintid: 10151093 rev_number: 10 eprint_status: archive userid: 699 dir: disk0/10/15/10/93 datestamp: 2022-07-01 10:02:06 lastmod: 2022-10-12 06:10:30 status_changed: 2022-07-01 10:02:06 type: article metadata_visibility: show sword_depositor: 699 creators_name: Bernatsky, Sasha creators_name: Ramsey-Goldman, Rosalind creators_name: Urowitz, Murray B creators_name: Hanly, John G creators_name: Gordon, Caroline creators_name: Petri, Michelle A creators_name: Ginzler, Ellen M creators_name: Wallace, Daniel J creators_name: Bae, Sang-Cheol creators_name: Romero-Diaz, Juanita creators_name: Dooley, Mary Anne creators_name: Peschken, Christine A creators_name: Isenberg, David A creators_name: Rahman, Anisur creators_name: Manzi, Susan creators_name: Jacobsen, Soren creators_name: Lim, S Sam creators_name: van Vollenhoven, Ronald creators_name: Nived, Ola creators_name: Kamen, Diane L creators_name: Aranow, Cynthia creators_name: Ruiz-Irastorza, Guillermo creators_name: Sanchez-Guerrero, Jorge creators_name: Gladman, Dafna D creators_name: Fortin, Paul R creators_name: Alarcon, Graciela S creators_name: Merrill, Joan T creators_name: Kalunian, Kenneth C creators_name: Ramos-Casals, Manuel creators_name: Steinsson, Kristjan creators_name: Zoma, Asad creators_name: Askanase, Anca creators_name: Khamashta, Munther A creators_name: Bruce, Ian creators_name: Inanc, Murat creators_name: Clarke, Ann E title: Cancer Risk in a Large Inception Systemic Lupus Erythematosus Cohort: Effects of Demographic Characteristics, Smoking, and Medications ispublished: pub divisions: C10 divisions: G90 divisions: B02 divisions: UCL divisions: D17 keywords: Science & Technology, Life Sciences & Biomedicine, Rheumatology, DISEASE-ACTIVITY, MALIGNANCY, HYDROXYCHLOROQUINE, AUTOPHAGY note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: Objective: To assess cancer risk factors in incident systemic lupus erythematosus (SLE). Methods: Clinical variables and cancer outcomes were assessed annually among incident SLE patients. Multivariate hazard regression models (overall risk and most common cancers) included demographic characteristics and time-dependent medications (corticosteroids, antimalarial drugs, immunosuppressants), smoking, and the adjusted mean Systemic Lupus Erythematosus Disease Activity Index 2000 score. Results: Among 1,668 patients (average 9 years follow-up), 65 cancers occurred: 15 breast, 10 nonmelanoma skin, 7 lung, 6 hematologic, 6 prostate, 5 melanoma, 3 cervical, 3 renal, 2 each gastric, head and neck, and thyroid, and 1 each rectal, sarcoma, thymoma, and uterine cancers. Half of the cancers (including all lung cancers) occurred in past/current smokers, versus one-third of patients without cancer. Multivariate analyses indicated that overall cancer risk was related primarily to male sex and older age at SLE diagnosis. In addition, smoking was associated with lung cancer. For breast cancer risk, age was positively associated and antimalarial drugs were negatively associated. Antimalarial drugs and higher disease activity were also negatively associated with nonmelanoma skin cancer risk, whereas age and cyclophosphamide were positively associated. Disease activity was associated positively with hematologic and negatively with nonmelanoma skin cancer risk. Conclusion: Smoking is a key modifiable risk factor, especially for lung cancer, in SLE. Immunosuppressive medications were not clearly associated with higher risk except for cyclophosphamide and nonmelanoma skin cancer. Antimalarials were negatively associated with breast cancer and nonmelanoma skin cancer risk. SLE activity was associated positively with hematologic cancer and negatively with nonmelanoma skin cancer. Since the absolute number of cancers was small, additional follow-up will help consolidate these findings. date: 2021-10-12 date_type: published publisher: WILEY official_url: https://doi.org/10.1002/acr.24425 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1750804 doi: 10.1002/acr.24425 medium: Print-Electronic lyricists_name: Rahman, Mohammed lyricists_name: Isenberg, David lyricists_id: ARAHM26 lyricists_id: DAISE40 actors_name: Rahman, Mohammed actors_id: ARAHM26 actors_role: owner funding_acknowledgements: [Montreal General Hospital Lupus Clinic]; [Singer Family Fund for Lupus Research]; 5UL1-TR-001422-02 [NIH]; 8UL1-TR-000150 [NIH]; UL-1RR-025741 [NIH]; K24-AR-02318 [NIH]; P60-AR-064464 [NIH]; P60-AR-48098 [NIH]; RR-00046 [NIH]; [Lupus UK]; [West Birmingham Hospitals NHS Trust]; AR-69572 [National Institute for Health Research/Wellcome Trust Birmingham Clinical Research Facility]; NRF-2017M3A9B4050335 [Republic of Korea]; [National Institute for Health Research University College London Hospitals Biomedical Research Centre]; A3865 [Danish Rheumatism Association]; A05990 [Novo Nordisk Foundation]; U01DP005119 [Centers for Disease Control and Prevention]; [Department of Education, Universities, and Research of the Basque Government]; [Arthritis Research UK]; [NIHR Manchester Biomedical Centre]; [NIHR/Wellcome Trust Manchester Clinical Research Facility]; [Arthritis Society Chair in Rheumatic Diseases at the University of Calgary] full_text_status: public publication: Arthritis Care & Research volume: 73 number: 12 pagerange: 1789-1795 pages: 7 event_location: United States citation: Bernatsky, Sasha; Ramsey-Goldman, Rosalind; Urowitz, Murray B; Hanly, John G; Gordon, Caroline; Petri, Michelle A; Ginzler, Ellen M; ... Clarke, Ann E; + view all <#> Bernatsky, Sasha; Ramsey-Goldman, Rosalind; Urowitz, Murray B; Hanly, John G; Gordon, Caroline; Petri, Michelle A; Ginzler, Ellen M; Wallace, Daniel J; Bae, Sang-Cheol; Romero-Diaz, Juanita; Dooley, Mary Anne; Peschken, Christine A; Isenberg, David A; Rahman, Anisur; Manzi, Susan; Jacobsen, Soren; Lim, S Sam; van Vollenhoven, Ronald; Nived, Ola; Kamen, Diane L; Aranow, Cynthia; Ruiz-Irastorza, Guillermo; Sanchez-Guerrero, Jorge; Gladman, Dafna D; Fortin, Paul R; Alarcon, Graciela S; Merrill, Joan T; Kalunian, Kenneth C; Ramos-Casals, Manuel; Steinsson, Kristjan; Zoma, Asad; Askanase, Anca; Khamashta, Munther A; Bruce, Ian; Inanc, Murat; Clarke, Ann E; - view fewer <#> (2021) Cancer Risk in a Large Inception Systemic Lupus Erythematosus Cohort: Effects of Demographic Characteristics, Smoking, and Medications. Arthritis Care & Research , 73 (12) pp. 1789-1795. 10.1002/acr.24425 <https://doi.org/10.1002/acr.24425>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10151093/2/Rahman_SLICCCancerMsJune30a2020_CLEAN%20COPY.pdf