Azathioprine may increase risk of cutaneous squamous cell carcinomas in solid organ transplant recipients

Jennifer R Dusendang and colleagues conducted a new study and discovered that the knowledge of risks and benefits in a wide range of patients can lead to improvements in care. The risk of cutaneous squamous cell carcinoma (cSCC) in solid organ transplant recipients (SOTRs) using modern immunosuppressive regimens must be understood. There is a scarcity of proper knowledge and guide for physicians in the prevention of cutaneous squamous cell carcinoma in solid organ transplant recipients, which can really be a major downside in the medical front.

Keeping the above information in mind researchers conducted this study with the objective to assess the risk of cSCC in relation to SOTR medications. The findings of this study were published in Journal of the American Academy of Dermatology.

From 2009 to 2019, 3308 SOTRs and 65,883 non-transplant recipients were included in this cohort and nest case-control study. Pathology data identified the incident cSCC, and pharmacy data identified the medications. Cox proportional hazards analysis was used to calculate adjusted hazard ratios and 95 percent confidence intervals (CIs), with voriconazole being studied as a time-dependent variable.

The findings of this study were as follows:

1. The annual incidence of cSCC was 1.69 percent in SOTRs and 0.30 percent in non-transplant recipients.

2. The adjusted hazard ratio for cSCC associated with lung transplant was 14.83 (95% CI, 9.85-22.33) for the lung and 6.53-10.69 for other organs.

3. Latinx people were at a higher risk than other non-White groups. The hazard ratio for each month of voriconazole use was 1.14 among lung recipients (95 percent CI, 1.04-1.26).

4. Azathioprine use for 7 months due to mycophenolate mofetil intolerance was linked to a 4.22-fold increased risk of cSCC (95 percent CI, 1.90-9.40).

5. Belatacept and other immunosuppressive medications were not linked to an increased risk.

In conclusion, the Authors added that Azathioprine has been linked to an increased incidence of cutaneous squamous cell carcinomas in solid organ transplant recipients, and it should be used with caution.

Reference:

Dusendang JR, Carlson E, Lee DS, Marwaha S, Madani S, Alexeeff SE, Webber A, Goes NB, Herrinton LJ. Cohort and nested case-control study of cutaneous squamous cell carcinoma in solid organ transplant recipients, by medication. J Am Acad Dermatol. 2021 Aug 9:S0190-9622(21)02275-1. doi: 10.1016/j.jaad.2021.07.065. Epub ahead of print. PMID: 34384835.