Use of Immunosuppression and the Risk of Subsequent Overall or Cancer Mortality

The article titled “Use of Immunosuppression and the Risk of Subsequent Overall or Cancer Mortality” by John H Kempen et al., published in Ophthalmology in 2023, presents findings from a retrospective cohort study aiming to determine the incidence of all-cause and cancer mortality associated with immunosuppression. The study involved patients with non-infectious ocular inflammatory disease (OID) from specialized centers, and exposure and covariate data were collected from clinic inception through 2010. Mortality data were obtained through the National Death Index linkage. The study analyzed various classes of immunosuppressants, including tumor necrosis factor (TNF) inhibitors, antimetabolites, calcineurin inhibitors, and alkylating agents, comparing them with unexposed individuals. Over 187,151 person-years of follow-up, involving 15,938 patients at risk, 1,970 deaths occurred, with 435 attributed to cancer.

The results indicated that patients unexposed to immunosuppressants and those exposed without systemic inflammatory diseases had similar mortality risks as the general population. Comparing patients exposed to different immunosuppressant classes with those not exposed, the study found no significant increase in overall or cancer mortality. Sensitivity analyses supported these results across various parameters. The study concluded that commonly used immunosuppressants, particularly antimetabolites, TNF inhibitors, and calcineurin inhibitors, were not associated with elevated overall or cancer mortality risk over a median follow-up of 10.0 years. This suggests the safety of these agents for patients undergoing immunosuppressive treatment for diverse inflammatory diseases.