Risk of Malignancy, Major Adverse Cardiovascular Events in Patients with Atopic Dermatitis

New findings presented at the Revolutionizing Atopic Dermatitis (RAD) 2024 Annual Meeting in Chicago suggest that individuals with atopic dermatitis are at lower risk of most malignancies as well as major adverse cardiovascular events (MACE) versus matched controls without atopic dermatitis (eczema) and those with rheumatoid arthritis.^1,2

These findings were the conclusions of 2 studies presented at RAD 2024. The first trial sought to assess eczema patients’ risk of malignancy, excluding non-melanoma skin cancers, comparing them to controls, individuals with rheumatoid arthritis, and those with moderate-to-severe disease.

The second trial sought to evaluate eczema patients’ risk of developing major adverse cardiovascular events compared to matched controls without the condition and those with rheumatoid arthritis. The study also assessed risk of developing MACE within a subgroup that had moderate-to-severe atopic dermatitis.

Risk of Malignancy

The first study was an observational claims-based trial in which investigators, using the Optum Clinformatics Data Mart, assessed individuals in the age range of ≥18 years with a diagnosis of atopic dermatitis or rheumatoid arthritis.¹

Over the course of the team’s research, from March 2017–December 2019, Patients were classified as having moderate-to-severe disease if they received dupilumab for eczema or advanced systemic therapy for rheumatoid arthritis at any time during the follow-up period.

The study included adults aged 18 and older diagnosed with eczema or rheumatoid arthritis. Those with atopic dermatitis were matched 1:1 with non-atopic dermatitis controls by sex, age (±1 year), and cohort entry date, with malignancies (excluding nonmelanoma skin cancers) found through 2 separate International Classification of Diseases diagnosis codes.

The research team identified 391,753 subjects with eczema and 97,455 subjects with rheumatoid arthritis, noting that incidence per 100 patient-years had been shown to be lower in among atopic dermatitis patients versus non-AD controls, patients with rheumatoid arthritis, and ones with moderate-to-severe eczema. Overall, risk of malignancy was far lower in patients with atopic dermatitis.

They did add, however, that there was not a substantial distinction observed in risk of malignancy between those with moderate-to-severe eczema and moderate-to-severe rheumatoid arthritis. Prior malignancy, older age, cardiovascular disease, asthma, smoking, and chronic liver disease were linked to increased risk in those with eczema. Those identified as females, Hispanics (compared to Whites), Asians, and those with a history of depression were shown to have a lower risk.

Risk of Major Adverse Cardiovascular Events

The investigators of this study used a retrospective trial design, assessing data from the Optum Clinformatics Data Mart and looking at individuals aged 18 and older with diagnoses of atopic dermatitis and an extended period for those with moderate-to-severe atopic dermatitis. TThree cohorts were assessed: non-AD controls, subjects with rheumatoid arthritis, and subjects with moderate-to-severe eczema.²

The research team defined major adverse cardiovascular events as stroke or myocardial infarction necessitating a minimum of a single day of hospitalization. The team sought to determine the participants’ relative risk of such events.

There were 391,753 participants with atopic dermatitis enrolled as well as 97,445 with rheumatoid arthritis. The investigators also had 381,221 matched atopic dermatitis and non-atopic dermatitis subjects.

The groups with moderate-to-severe atopic dermatitis and non-atopic dermatitis each contained 7,134 individuals. Overall, the research team determined that incidence of major adverse cardiovascular events in those with eczema had been comparable to the controls without and lower than those with rheumatoid arthritis.

Subjects with moderate-to-severe atopic dermatitis were shown to have lower incidence compared to non-atopic dermatitis controls as well as those with moderate-to-severe rheumatoid arthritis. Higher risk of such events in those with atopic dermatitis was linked to those who were male, older, Black, previously hospitalized, recently using systemic corticosteroids, and had a history of cardiovascular disease, smoking, drugs, and other comorbidities.

References

1. ^{Vleugels R, Grada A, Krueger W, et al. Risk of Malignancy Excluding Nonmelanoma Skin Cancer in Patients With Moderate‑to‑Severe Atopic Dermatitis in the United States: A Population-Based Study Using Claims Data. Revolutionizing Atopic Dermatitis (RAD) 2024 Annual Meeting June 8 – 10, 2024. Chicago, IL.}
2. ^{Bunick C, Grada A, Krueger W, et al. Risk of Major Adverse Cardiovascular Events in Patients With Moderate‑to‑Severe Atopic Dermatitis: A United States Population‑Based Study. Revolutionizing Atopic Dermatitis (RAD) 2024 Annual Meeting June 8 – 10, 2024. Chicago, IL.}