(240) Incidence Rate of Skin Cancers in Adult Patients with Atopic Dermatitis

Publication Number: 1285

Background: Limited data exist on the incidence rate (IR) of skin cancers in patients with atopic dermatitis (AD) on different AD therapies.

Objectives: To assess the IR of melanoma and non-melanoma skin cancer (NMSC) in adult patients with AD.

Methods: A retrospective cohort study was conducted in the Optum™ Clinformatics™ Data Mart (CDM). Adult (18+ years) patients with AD were identified from 2014-2019 using ≥2 claims for AD or ≥1 claim for AD or eczema and ≥2 historic claims for asthma, allergic rhinitis, or food allergies. These patients were classified into cohorts 1 (who received systemic therapy, or class 1-2 topical corticosteroids (TCS)), cohort 2 (who received topical TCS class 3-7, calcineurin inhibitors, or crisaborole), and cohort 3 (who received no therapy). Patients with AD were matched with individuals without AD (non-AD cohort 4) on age, sex, and cohort entry date (CED) using risk set sampling. Incident melanoma and NMSC were safety outcomes defined based on one inpatient or two outpatient diagnosis codes. Crude IR and 95% confidence intervals (CI) were estimated for each cohort. Adjusted hazard ratios (HRs) and 95% CI were generated using Cox regression for cohorts 1-3, compared with cohort 4. Analyses were completed on the Aetion Evidence Platform® vR4.33.1.

Results: Cohorts 1-4 included 297,597, 238,297, 115,988, and 1,245,508 subjects, respectively. The mean age (SD) was similar across cohorts (56.9±18.6 years) and 66.4% were female. Their pre-enrollment before CED was 6.04 ± 3.19, 5.98 ± 3.21, 5.18 ± 3.02, and 4.44 ± 2.91 years, respectively. Within one year before CED, the proportion of any inpatient hospitalization was 18.2%, 16.8%, 19.4% and 9.1%, respectively. Cardiovascular disease, a risk factor for cancer, was present in 69.6%, 69.6%, 64.2% and 51.1% of cohorts 1 to 4, respectively. The crude IR (95% CI) per 100 person-years were 0.26 (0.21, 0.31), 0.37 (0.30, 0.45), 0.15 (0.14, 0.17), and 0.10 (0.10, 0.10) for melanoma and 2.95 (2.77, 3.13), 4.85 (4.57, 5.14), 1.91 (1.85, 1.97,) and 1.18 (1.16, 1.19), for NMSC, respectively. The most common NMSC was basal cell carcinoma, followed by squamous cell carcinoma. Compared with cohort 4, the adjusted HRs and 95% CI were 2.06 (1.67, 2.54), 2.85 (2.25, 3.61), and 1.30 (1.17, 1.46) for melanoma and 2.02 (1.89, 2.15), 3.38 (3.16, 3.62), and 1.42 (1.37, 1.46) for NMSC, respectively, for cohort 1-3. Cardiovascular disease was independently associated with increased risk for melanoma (HR 1.22, 95% CI 1.12, 1.32) and NMSC (HR 1.27, 95% CI 1.24, 1.30).

Conclusions: A higher risk of skin cancers was observed in AD compared with the non-AD population. For AD patients, the risk was higher for those receiving systemic therapy or superpotent TCS and for those receiving topical agents.