July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Risk of Overall and Cancer Mortality After Immunosuppression of Patients with Non-infectious Ocular Inflammatory Diseases.
Author Affiliations & Notes
  • John H Kempen
    Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
    MCM Eye Unit; MyungSung Christian Medical Center and Medical College, Addis Ababa, Ethiopia
  • Craig W Newcomb
    Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Charles S Foster
    Massachusetts Eye Research and Surgery Institute, Waltham, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Douglas A Jabs
    Ophthalmology and Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
    Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Grace Levy-Clarke
    Clinical Research, Tampa Bay Uveitis Center, Tampa, Florida, United States
    Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
  • James T Rosenbaum
    Devers Eye Institute, Portland, Oregon, United States
    Ophthalmology (Casey Eye Institute) and Medicine, Oregon Health & Sciences University, Portland, Oregon, United States
  • H Nida Sen
    Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
  • Eric B Suhler
    Ophthalmology (Casey Eye Institute), Oregon Health & Sciences University, Portland, Oregon, United States
    Ophthalmology, Portland Veterans Affairs Medical Center, Portland, Oregon, United States
  • Jennifer E Thorne
    Ophthalmology (Wilmer Eye Institute), Johns Hopkins School of Medicine, Baltimore, Maryland, United States
    Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Nirali P Bhatt
    Ophthalmology (Scheie Eye Institute), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Jeanine M Buchanich
    Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   John Kempen, Christoffel Blindenmission (F), Gilead (C), National Eye Institute (F), Santen (C), Sight for Souls (F); Craig Newcomb, None; Charles S Foster, None; Douglas Jabs, None; Grace Levy-Clarke, abbvie (C), allergan (F), mallinckrodt (F); James Rosenbaum, abbvie (C), Alcon Research Institute (F), Eyevensys (C), Gilead (C), Janssen (C), Novartis (C), Pfizer (F), Roche (C), UpToDate (C); H Nida Sen, None; Eric Suhler, Abbvie (C), Abbvie (F), BMS (F), Evenensys (C); Jennifer Thorne, Abbvie (C), National Eye Institute (F); Nirali Bhatt, None; Jeanine Buchanich, None
  • Footnotes
    Support  NEI/NIH Grant EY014943; Research to Prevent Blindness; NEI Intramural Support; Department of Veterans' Affairs
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3854. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      John H Kempen, Craig W Newcomb, Charles S Foster, Douglas A Jabs, Grace Levy-Clarke, James T Rosenbaum, H Nida Sen, Eric B Suhler, Jennifer E Thorne, Nirali P Bhatt, Jeanine M Buchanich; Risk of Overall and Cancer Mortality After Immunosuppression of Patients with Non-infectious Ocular Inflammatory Diseases.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3854.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract

Purpose : To test whether use of immunosuppressive agents for ocular inflammatory diseases is associated with an altered risk of overall and cancer mortality.

Methods : Retrospective cohort study of all eligible patients seen at five ocular inflammation centers plus Tumor Necrosis Factor Inhibitor (TNF-I)-treated patients and matched controls at five other centers from inception through 31 December 2010. Patients with non-infectious ocular inflammation (uveitis, scleritis, pemphigoid with eye involvement, or others) were included unless they had HIV infection or (for this analysis) cancer. Overall and cancer-specific mortality was studied, obtained by linkage to the National Death Index (NDI) (1979-2013); death was attributed to cancer when the NDI indicated cancer was identified on the death certificate as cause of death. Exposures of primary interest were use of TNF-I, antimetabolites, calcineurin inhibitors, and alkylating agents. Exposure data were obtained by retrospective chart review, entering data on every patient at every visit. Relative hazard (RH) of overall or cancer mortality for the exposures of interest was assessed by survival analysis, adjusting for additional predictive factors, either including all patients or excluding those with systemic inflammatory diseases (who may have increased risk of death or cancer).

Results : Among 15,938 patients followed over 187,151 person-years, 1970 died (435 cancer deaths). Counts (Median follow-up time in years) of patients exposed to immunosuppression include: TNF-I: 1,333 (6.3); antimetabolites: 4,730 (8.2); calcineurin inhibitors: 1,558 (9.8); alkylating agents: 892 (9.4). RH’s are summarized in the forest plot images. Results excluding the first three to five years after exposure generally were similar; no cumulative dose or maximum dose thresholds with different outcome patterns were found.

Conclusions : The immunosuppressive agents commonly used for ocular inflammatory diseases, including TNF-I’s, were not associated with increased overall or cancer mortality. Alkylating agents were associated with higher overall mortality, but not after excluding patients with systemic inflammatory diseases (some with high mortality). Higher mortality in some tacrolimus and etanercept analyses might reflect selection factors (e.g., transplantation) and require further study.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

 

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×