Long-term Rik of Malignancy Among Patient Treated With Immunouppreive Agent for Ocular Inflammation: A Critical Aement of the Evidence Original Reearch Article

Purpoe To critically ae potentially carcinogenic effect of immunouppreive therapy in the ocular inflammation etting. Deign Focued evidence aement. Method Relevant publication were identified by MEDLINE and EMBAE querie and reference lit earche. Reult Extrapolation from tranplant, rheumatology, kin dieae, and inflammatory bowel dieae cohort to the ocular inflammation etting ugget that: 1) alkylating agent increae hematologic malignancy rik and cyclophophamide increae bladder cancer rik, but le o with ≤18 monthʹ duration of therapy and hydration, repectively; 2) calcineurin inhibitor and azathioprine probably do not increae total cancer rik to a detectable degree, except perhap ome other rik factor (uncommon in ocular inflammation patient) might interact with the former to raie rik; 3) tumor necroi factor (TNF) inhibitor may accelerate diagnoi of cancer in the firt ix to 12 month, but probably do not increae long-term cancer rik; and 4) change in rik with methotrexate, mycophenolate mofetil, and daclizumab appear negligible, although nontranplant data are limited for the latter agent. Immunouppreion in general may increae kin cancer rik in a un expoure–dependent manner. Concluion Ue of alkylating agent for a limited duration eem jutifiable for evere, viion-threatening dieae, but otherwie cancer rik may be a relevant contraint on ue of thi approach. Antimetabolite, daclizumab, TNF inhibitor, and calcineurin inhibitor probably do not increae cancer rik to a degree that outweigh the expected benefit of therapy. Monitoring for kin cancer may be ueful for highly un-expoed patient. Data from ocular inflammation patient are needed to confirm the concluion made in thi analyi by extrapolation.