Spironolactone Not Associated With Recurrence of Breast Cancer

The use of spironolactone for alopecia was not associated with estrogen-dependent cancer recurrence.

The following article is part of coverage from the American Academy of Dermatology’s Annual Meeting (AAD 2020). Because of concerns regarding the coronavirus disease 2019 (COVID-19) pandemic, all AAD 2020 sessions and presentations were transitioned to a virtual format. While live events will not proceed as planned, readers can click here to view more news related to research presented during the AAD VMX 2020 virtual experience.

Spironolactone was not associated with breast cancer recurrence, according to study results presented at the American Academy of Dermatology’s Virtual Meeting Experience (AAD VMX) 2020, held online from June 12 to 14, 2020.  

Because of its ability to halt hair loss progression and long-term safety profile, spironolactone is used off-label for androgenic alopecia. However, spironolactone’s estrogenic effects have been hypothesized to affect breast cancer recurrence. To investigate this hypothesis, researchers conducted a retrospective cohort study using data abstracted from the Humana insurance database. Patients with a history of breast cancer were identified using the associated International Classification of Diseases codes. Patients were divided into cohorts based on spironolactone usage and further matched 1:1 using propensity score analysis to adjust for patient characteristics. The primary outcome was breast cancer recurrence. Hazard ratios (HRs) for cancer recurrence were calculated using Cox proportional hazard models.

In total, 746 (2.6%) of patients with a history of breast cancer used spironolactone. During 2 years of follow-up, 123 (16.5%) patients developed recurrent breast cancer. After performing a 1:1 propensity score matching with the nonspironolactone cohort, the risk for breast cancer recurrence was not significantly increased with spironolactone use (P = .779). In unadjusted pre-match models, the HR for cancer recurrence was 1.08 (95% CI, 0.95-1.23; P = .227) in patients taking sprionolactone. In adjusted pre-match and post-match models, alcohol abuse emerged as a consistent risk factor for cancer recurrence, while spironolactone use did not.

Per these data, spironolactone may be a viable treatment option for patients with alopecia and a history of breast cancer. Future prospective studies with a longer follow-up duration are necessary to confirm these results.

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Wei C, Friedman AJ, Bovonratwet P, Gu A, Moawad G. Spironolactone use does not increase the risk of estrogen-dependent cancer recurrence: a retrospective analysis. Presented at: AAD VMX 2020; June 12-14, 2020. Abstract/Poster 15809.