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Abstract Number: 2588

Updated Analyses of Cancer Incidence and Risk Factors in a Large International SLE Cohort

Sasha Bernatsky1, Rosalind Ramsey-Goldman2, Murray Urowitz3, John G. Hanly4, Caroline Gordon5, Michelle Petri6, Ellen Ginzler7, Daniel Wallace8, Sang-Cheol Bae9, Juanita Romero-Diaz10, Mary Anne Dooley11, Christine Peschken12, David Isenberg13, Anisur Rahman14, Susan Manzi15, Soren Jacobsen16, S. Sam Lim17, Ronald van Vollenhoven18, Ola Nived19, Diane L. Kamen20, Cynthia Aranow21, Jill Buyon22, Guillermo Ruiz-Irastorza23, Francisco Sanchez-Guerrero24, Dafna Gladman25, Paul R. Fortin26, Jennifer LF Lee27, Luck Lukusa27, Graciela S Alarcón28, Joan Merrill29, Kenneth Kalunian30, Manuel Ramos-Casals31, Kristjan Steinsson32, Asad Zoma33, Anca Askanase34, Munther Khamashta35, Ian Bruce36, Murat Inanç37 and Ann Clarke38, 1Research Institute of the McGill University Health Centre, Montreal, QC, Canada, 2Northwestern University, Chicago, IL, 3Schroeder Arthritis Institute, Krembil Research Institute; University of Toronto Lupus Clinic; Division of Rheumatology, Toronto, ON, Canada, 4Dalhousie University, Halifax, NS, Canada, 5Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom, 6Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Timonium, MD, 7SUNY Downstate Health Sciences University, Brooklyn, NY, 8Cedars-Sinai Medical Center, Los Angeles, CA, 9Hanyang University Hospital for Rheumatic Diseases and Hanyang University Institute for Rheumatology Research, Department of Rheumatology, Seoul, South Korea, 10Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico, 11Raleigh Neurology Associates, Chapel Hill, NC, 12University of Manitoba, Winnipeg, MB, Canada, 13University College London, London, United Kingdom, 14Centre for Rheumatology, Division of Medicine, University College London, London, United Kingdom, 15Lupus Center of Excellence, Autoimmunity Institute, Allegheny Health Network, Pittsburgh, PA, 16Rigshospitalet, Copenhagen, Denmark, 17Emory University, Atlanta, GA, 18Amsterdam University Medical Centers, Amsterdam, Netherlands, 19Department of Rheumatology, Institution of Clinical Sciences, Lund University Hospital, Lund, Sweden, 20Medical University of South Carolina, Charleston, SC, 21Feinstein Institutes for Medical Research, Manhasset, NY, 22NYU Grossman School of Medicine, New York, NY, 23Hospital Universitario Cruces, Barakaldo, Spain, 24University Health Network/Sinai Health system, Toronto, ON, Canada, 25Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Department of Medicine, University of Toronto, Toronto, ON, Canada, 26Centre ARThrite - CHU de Québec - Université Laval, Quebec City, QC, Canada, 27RI-MUHC, Montreal, QC, Canada, 28Heersink School of Medicine. The University of Alabama at Birmingham, Birmingham, AL, 29Oklahoma Medical Research Foundation, Oklahoma City, OK, 30University of California San Diego, La Jolla, CA, 31Hospital Clinic, Barcelona, Barcelona, Spain, 32Landspitali University Hospital, Reykjavik, Iceland, 33Lanarkshire Centre for Rheumatology and Hairmyres Hospital, East Kilbride, East Kilbride, United Kingdom, 34Columbia University Medical Center, New York, NY, 35GSK Gulf, Medical Affairs Department, Dubai, United Arab Emirates, 36University of Manchester, Manchester, United Kingdom, 37Istanbul University, Istanbul, Turkey, 38University of Calgary, Division of Rheumatology, Cumming School of Medicine, Calgary, AB, Canada

Meeting: ACR Convergence 2023

Keywords: Cohort Study, Epidemiology, risk factors, Systemic lupus erythematosus (SLE)

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Session Information

Date: Wednesday, November 15, 2023

Title: Abstracts: SLE – Diagnosis, Manifestations, & Outcomes IV: Outcomes & Comorbidity

Session Type: Abstract Session

Session Time: 11:00AM-12:30PM

Background/Purpose: Many studies of cancer risk in SLE are limited by small sample size or use of administrative data, which rely on billing code diagnoses instead of clinical data. We produced updated estimates cancer risk in the largest-ever cohort of clinically confirmed incident SLE patients.

Methods: Adults with SLE were enrolled (within 15 months of diagnosis) into the SLICC Inception Cohort, across 32 centres. Individuals were followed with annual assessments, where detailed data was collected on Disease Activity Index-2000 (SLEDAI-2K), lupus drugs in the past year, and documentation of cancer diagnoses (by the examining physician at yearly intervals).

We performed univariate and multivariate Cox regression, with baseline demographics (age at SLE onset, race/ethnicity, sex), and time-dependent variables for medications (antimalarials, biologics and other immunosuppressives, corticosteroids), smoking, and SLEDAI-2K. As well as cancer over-all, we evaluated risk factors for the most common cancer types.

Results: Of 1848 new-onset SLE patients enrolled between 1999-2011, 1675 had at least one follow-up; these were the sample for the current analysis. End date was the first of death, last visit, or end of study interval for this analysis (June 21,2021). Baseline demographics are shown in Table 1.

Over 16493 years of follow-up (median follow up, 10 years) 72 cancers occurred (incidence 4. 4 events per 1,000 patient-years). This included 16 breast cancers, 10 non-melanoma skin, 10 lung, 6 hematological, 6 prostate, 5 melanoma, 3 cervical, 3 renal, 3 head and neck, 3 thyroid, 2 gastric, 2 uterine, and one each rectal, sarcoma, thymoma. Adjusted and unadjusted hazard ratios (HR) are shown in Table 2. Multivariate analyses of all cancer types (analyzed together) suggested a higher risk of cancer among patients of older age, males, and those who smoked more than 15 cigarettes a day.

In the multivariate analyses specifically for breast cancer, age at SLE diagnoses remained a risk factor, and antimalarials were associated with a decreased risk. This effect of antimalarials was not clearly seen for any other cancer type. For non-melanoma skin cancer, both age at SLE diagnosis and cyclophosphamide (albeit with a wide confidence interval) were associated with risk. For hematologic cancers, older age was a risk factor in univariate analyses (hazard ratio, HR 1.06, 95% confidence interval, CI 1.01 , 1.12) as was highest quartile of SLEDAI-2k (HR 10.3, 95% CI 1.31 , 81.7), but due to the low number of hematologic cancers, multivariate estimates were less precise and confidence intervals included the null value for all variables.

Conclusion: Our updated analyses of this large, international inception SLE cohort continues to illustrate how different cancer types in SLE might be associated with specific risk factors. Additional follow-up is still needed to precisely determine the potential effects of disease activity (particularly for hematologic malignancies) and medications on cancer risk in SLE.

Supporting image 1

Table 1. Baseline characteristics of the SLE sample

Supporting image 2

Table 2. Hazard Ratio (HR) for cancer in SLE (Cox regression analysis)


Disclosures: S. Bernatsky: None; R. Ramsey-Goldman: Ampel Solutions, 2, Calabetta, 2, Exagen, 2, Immunocor, 6; M. Urowitz: None; J. Hanly: None; C. Gordon: AbbVie, 2, Alumis, 2, Amgen, 2, AstraZeneca, 2, Sanofi, 2, UCB Pharma, 2; M. Petri: Alexion, 1, Amgen, 1, AnaptysBio, 1, Annexon Bio, 1, Argenx, 1, Arhros-Focus Med/Ed, 6, AstraZeneca, 1, 5, Aurinia, 1, 5, 6, Axdev, 1, Biogen, 1, Boxer Capital, 2, Cabaletto Bio, 2, Caribou Biosciences, 2, CVS Health, 1, Eli Lilly, 1, 5, Emergent Biosolutions, 1, Exagen, 5, Exo Therapeutics, 2, Gilead Biosciences, 2, GlaxoSmithKlein(GSK), 1, 5, 6, Horizon Therapeutics, 2, Idorsia Pharmaceuticals, 2, IQVIA, 1, Janssen, 1, 5, Kira Pharmaceuticals, 2, MedShr, 6, Merck/EMD Serono, 1, Momenta Pharmaceuticals, 2, Nexstone Immunology, 2, Nimbus Lakshmi, 2, Proviant, 2, Sanofi, 2, Sinomab Biosciences, 2, Thermofisher, 5, UCB, 2; E. Ginzler: None; D. Wallace: None; S. Bae: None; J. Romero-Diaz: None; M. Dooley: None; C. Peschken: AstraZeneca, 2, 5, GSK, 2, 5, Roche, 1, 2; D. Isenberg: None; A. Rahman: None; S. Manzi: AbbVie, 5, Allegheny Singer Research Institute, 10, AstraZeneca, 2, 5, Exagen Diagnostics, Inc, 2, 9, 10, GSK, 2, 5, Lilly, 2, Lupus Foundation of America, 4, Novartis, 2, UCB Advisory Board, 2, Univiersity of Pittsburgh, 10; S. Jacobsen: None; S. Lim: None; R. van Vollenhoven: AbbVie, 2, 6, AstraZeneca, 2, 5, 6, Biogen, 6, Bristol-Myers Squibb(BMS), 2, 5, 6, Galapagos, 2, 5, 6, GlaxoSmithKline, 6, Janssen, 2, 6, MSD/Merck Sharp and Dohme, 5, Novartis, 5, Pfizer, 2, 5, 6, RemeGen, 2, Roche, 5, Sanofi, 5, UCB, 2, 5, 6; O. Nived: None; D. Kamen: None; C. Aranow: AstraZeneca, 2, Bristol-Myers Squibb(BMS), 2, GlaxoSmithKlein(GSK), 2, 5, kezar Inc, 2; J. Buyon: Bristol-Myers Squibb(BMS), 2, GlaxoSmithKlein(GSK), 2, Related Sciences, 1; G. Ruiz-Irastorza: None; F. Sanchez-Guerrero: None; D. Gladman: AbbVie, 2, 5, Amgen, 2, 5, Bristol Myers Squibb, 2, Celgene, 2, 5, Eli Lilly, 2, 5, Galapagos, 2, Gilead Sciences, 2, Janssen, 2, 5, Novartis, 2, 5, Pfizer Inc, 2, 5, UCB, 2, 5; P. Fortin: AbbVie, 1, AstraZeneca, 1, 6, GlaxoSmithKlein(GSK), 1, 6, Roche-Genentech, 1; J. Lee: None; L. Lukusa: None; G. Alarcón: None; J. Merrill: AbbVie, 2, Alexion, 2, Alumis, 2, Amgen, 2, AstraZeneca, 2, 5, Aurinia, 2, Bristol Myers Squibb, 2, 5, EMD Serono, 2, Genentech, 2, Gilead, 2, GlaxoSmithKline, 2, 5, Lilly, 2, Merck, 2, Pfizer, 2, Provention, 2, Remegen, 2, Sanofi, 2, UCB Pharma, 2, Zenas, 2; K. Kalunian: AbbVie/Abbott, 2, Amgen, 5, AstraZeneca, 2, Aurinia, 2, Bristol-Myers Squibb(BMS), 2, Eli Lilly, 2, EquilliumBio, 2, Genentech, 2, Gilead, 2, Janssen, 2, KezarBio, 1, Merck/MSD, 2, Novartis, 2, Pfizer, 2, Remegene, 2, Roche, 2, UCB, 5; M. Ramos-Casals: None; K. Steinsson: None; A. Zoma: None; A. Askanase: AbbVie, 2, Amgen, 2, AstraZeneca, 2, Aurinia, 2, Bristol-Myers Squibb, 2, Celgene, 2, Eli Lilly, 2, Genentech, 2, GSK, 2, Idorsia, 2, Janssen, 2, Mallinckrodt, 2, Pfizer, 2, UCB Pharma, 2; M. Khamashta: GSK, 3, 11; I. Bruce: AstraZeneca, 1, 2, 5, 6, Aurinia, 2, GSK, 1, 2, 5, 6, Janssen, 5, 6, Lilly, 1, UCB, 6; M. Inanç: Boehringer-Ingelheim, 6, Pfizer, 6, UCB, 6; A. Clarke: AstraZeneca, 2, Bristol-Myers Squibb(BMS), 2, GlaxoSmithKlein(GSK), 2, 5, Otsuka, 2, Roche, 2.

To cite this abstract in AMA style:

Bernatsky S, Ramsey-Goldman R, Urowitz M, Hanly J, Gordon C, Petri M, Ginzler E, Wallace D, Bae S, Romero-Diaz J, Dooley M, Peschken C, Isenberg D, Rahman A, Manzi S, Jacobsen S, Lim S, van Vollenhoven R, Nived O, Kamen D, Aranow C, Buyon J, Ruiz-Irastorza G, Sanchez-Guerrero F, Gladman D, Fortin P, Lee J, Lukusa L, Alarcón G, Merrill J, Kalunian K, Ramos-Casals M, Steinsson K, Zoma A, Askanase A, Khamashta M, Bruce I, Inanç M, Clarke A. Updated Analyses of Cancer Incidence and Risk Factors in a Large International SLE Cohort [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/updated-analyses-of-cancer-incidence-and-risk-factors-in-a-large-international-sle-cohort/. Accessed .
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