Risk of Non-Melanoma Skin Cancer in Association with Use of Hydrochlorothiazide-Containing Products in the United States
Menée aux Etats-Unis à partir de données portant sur plus de 5,2 millions de personnes, cette étude analyse l'association entre une utilisation de produits contenant de l'hydrochlorothiazide (traitements de l'hypertension ou de l'oedème) et le risque de carcinome basocellulaire ou épidermoïde de la peau
European studies reported an increased risk of non-melanoma skin cancer associated with hydrochlorothiazide (HCTZ)-containing products. We examined the risks of basal cell (BCC) and squamous cell carcinoma (SCC) associated with HCTZ compared to angiotensin-converting enzyme inhibitors (ACEIs) in a US population.We conducted a retrospective cohort study in the US Food and Drug Administration’s Sentinel System. From the date of HCTZ or ACEI dispensing, patients were followed until a SCC or BCC diagnosis requiring excision or topical chemotherapy treatment on or within 30 days after the diagnosis date; or a censoring event. Using Cox proportional hazards regression models, we estimated the hazard ratios (HRs), overall and separately by age, sex, and race. We also examined site- and age-adjusted incidence rate ratios (IRRs) by cumulative HCTZ dose within the matched cohort.Among 5.2 million propensity-score matched HCTZ and ACEI users, the incidence rate (per 1,000 person-years) of BCC was 2.78 and 2.82 respectively, and 1.66 and 1.60 for SCC. Overall, there was no difference in risk between HCTZ and ACEIs for BCC (HR = 0.99, 95% CI = 0.97–1.00), but an increased risk for SCC (HR = 1.04, 95% CI = 1.02–1.06). HCTZ use was associated with higher risks of BCC (HR = 1.09, 95% CI = 1.07–1.11) and SCC (HR = 1.15, 95% CI = 1.12–1.17) among Caucasians. Cumulative HCTZ dose ≥50,000mg was associated with an increased risk of SCC in the overall population (IRR =1.19, 95% CI = 1.05–1.35) and among Caucasians (IRR = 1.27, 95% CI = 1.10–1.47).Among Caucasians, we identified small increased risks of BCC and SCC with HCTZ compared to ACEI. Appropriate risk mitigation strategies should be taken while using HCTZ.
JNCI Cancer Spectrum 2021