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  • Uveitis

    Review of: Use of immunosuppression and the risk of subsequent overall or cancer mortality

    Kempen J, Newcomb C, Washington T, et al. Ophthalmology, December 2023

    Data from the long-term Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study, conducted among ocular inflammatory disease (OID) subspecialty centers in the United States, indicate that immunosuppressive therapy for OID does not appear to increase mortality risk.

    Study Design

    This subanalysis of the SITE Cohort Study included records from 1979 to 2010 on 15,938 patients with OID, 27% of whom also had systemic inflammatory disease (SID). Patients were excluded if they had a pre-existing history of cancer or human immunodeficiency virus infection. Thirty-six percent of patients received at least 1 class of immunosuppressive agent, including tumor necrosis factor (TNF) inhibitors, antimetabolites, calcineurin inhibitors, and alkylating agents.


    The median follow-up time was 10 years. Over 187,151 person-years, 1970 deaths were observed, 435 of which were due to cancer. The risk of mortality in patients not given immunosuppressive therapy was similar to that seen in the general US population. Taking immunosuppressants of any class did not increase the general risk of overall or cancer-related mortality. Patients with SID had higher mortality rates than those who did not regardless of whether they were exposed to immunosuppressants.


    While the study did show that over a median of 10 years these agents did not increase overall or cancer-related mortality, there is evidence that longer-term or lifelong use of immunosuppressive therapy, such as in the case of transplant patients, is associated with an increased risk of mortality. This study of patients with OID did not look at usage beyond a median of 10 years. Additionally, the findings may not be applicable for less commonly used immunosuppressants.

    Clinical Significance

    Previously published SITE data suggested a slightly increased risk of overall and cancer mortality with the usage of TNF inhibitors, but these findings were not replicable when looking at larger numbers of patients and longer follow-up times. The results of this analysis may be reassuring for clinicians and their patients with OID who are being treated with immunosuppressive therapy, though longer-term data are needed.

    Financial Disclosures: Dr. Sruthi Arepalli discloses financial relationships with AbbVie, Alimera Sciences, and Eyepoint (Consultant/Advisor).