与HCQ相比,SLE用免疫抑制剂发生宫颈癌的可能性更大
前沿进展丨与羟氯喹相比，狼疮患者用免疫抑制剂发生宫颈癌的可能性更大
目的：既往研究提示，系统性红斑狼疮女性罹患宫颈癌的风险增加。但是免疫抑制剂的应用与宫颈癌之间的关系并未在美国全国队列中进行充分研究。本研究比较了初始应用免疫抑制剂治疗与应用羟氯喹治疗的SLE女性罹患宫颈重度异性增生与宫颈癌的风险之间的差别。
方法：我们研究对象为两个健康计划及医疗计划中自2000至2012年应用免疫抑制剂或羟氯喹的狼疮女性患者。我们应用严格标准定义宫颈重度不典型增生以及宫颈癌。评估可能的干扰因素，如人口统计学因素，合并症，用药因素，HPV疫苗接种情况以及健康保健情况。经倾向性指数匹配后初始应用免疫抑制剂及羟氯喹的患者比例为1:1.应用反向方差加权，固定效应模型计算两组患者的风险比。
结果：在商业队列中我们共纳入2451对初始应用免疫抑制剂及初始应用羟氯喹的配对患者，在医疗队列中纳入了7690对患者。在商业队列中，应用免疫抑制剂组共有14例患者出现宫颈重度不典型增生或宫颈癌，而羟氯喹组出现了5例(HR 2.47, 95% CI 0.89-6.85, 羟氯喹 = ref)。在医疗队列组，免疫抑制剂组出现宫颈重度不典型增生或宫颈癌共46例，羟氯喹组为29例(HR 1.24, 95% CI 0.78-1.98, 羟氯喹= ref).免疫抑制剂组与羟氯喹组比风险比为1.40(95% CI 0.92-2.12).
结论：对于狼疮女性患者而言，与应用羟氯喹的患者相比，应用免疫抑制剂的患者可能具有罹患宫颈重度不典型增生和宫颈癌的更高风险，虽然这种风险还不具有显著统计学差异。
附原文：
Abstract：Objective Prior studies suggest anincreased risk of cervical cancer among women with systemic lupus erythematosus.However, the relationship with immunosuppressive drugs is notwell studied in US nationwide cohorts. We comparedthe risk of high-grade cervical dysplasia and cervical cancer among women with systemic lupus erythematosus whostarted immunosuppressive drugs versus hydroxychloroquine.Methods We identified systemic lupus erythematosus patientsinitiating immunosuppressive drugs or hydroxychloroquine usingclaims data from two US commercial health plans and Medicaid (2000-2012). Weused a validated claims-based algorithm to identify high-grade cervical dysplasia or cervical cancer.To account for potential confounders, including demographic factors,comorbidities, medication use, HPV vaccination status, and health careutilization, immunosuppressive drugs and hydroxychloroquineinitiators were 1:1 matched on the propensity score. We used inverse variance-weighted,fixed effect models to pool hazard ratios from the propensity score-matchedMedicaid and commercial cohorts. Results We included 2451 matched pairs of immunosuppressive drugs andhydroxychloroquine new users in the commercial cohort and 7690 matched pairs inMedicaid. In the commercial cohort, there were 14 casesof cervical dysplasia or cervical cancer among immunosuppressive drugs usersand five cases among hydroxychloroquine users (hazard ratio 2.47,95% CI 0.89-6.85, hydroxychloroquine=ref). In Medicaid,there were 46 cases among immunosuppressive drugs users and 29cases in hydroxychloroquine users (hazard ratio 1.24, 95% CI 0.78-1.98,hydroxychloroquine=ref). The pooled hazardratio of immunosuppressive drugs was 1.40 (95% CI 0.92-2.12). ConclusionAmong women with systemic lupus erythematosus, immunosuppressive drugs maybe associated with a greater, albeit not statisticallysignificant, risk of high-grade cervical dysplasia and cervical cancer comparedto patients receiving hydroxychloroquine alone.
引自：
Feldman CH, Liu J, Feldman S,et al. Risk of high-grade cervical dysplasia and cervical cancer in women with systemic lupuserythematosus receiving immunosuppressive drugs.Lupus. 2017 Jun;26(7):682-689.
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