Risk for Cutaneous Squamous Cell Carcinoma Increased With Photosensitizing Antihypertensive Drugs

An increased risk for cutaneous squamous cell carcinoma (cSCC) has been demonstrated among individuals who are treated with photosensitizing antihypertensive drugs (ADs), suggesting that patients who receive these agents may benefit from education on safe sun practices and closer cSCC screening, according to the results of a cohort study published in the British Journal of Dermatology.

With the knowledge that many ADs are photosensitizing, the investigators sought to examine the association between AD use and risk for cSCC among a cohort of non-Hispanic white patients with hypertension.

They used electronic pharmacy data to determine exposure to ADs, which were classified in 1 of 3 categories: photosensitizing (alpha-2 receptor agonists and diuretics [loop, potassium sparing, thiazide, and a combination]), nonphotosensitizing (alpha-blockers, beta-blockers, central agonists, and angiotensin receptor blockers), and unknown photosensitizing potential (angiotensin-converting enzyme inhibitors, calcium channel blockers, vasodilators, and combinations).

Among a total of 28,357 patients with hypertension enrolled in the health care delivery system, cSCC developed in 3010 during follow-up. Compared with non-use of ADs, the risk for cSCC was increased with ever-use of photosensitizing ADs (adjusted hazard ratio [aHR] 1.17; 95% CI, 1.07-1.28) and ever-use of ADs of unknown photosensitizing potential (aHR 1.11; 95% CI, 1.02-1.20). In contrast, no association was observed with the ever-use of nonphotosensitizing ADs (aHR 0.99; 95% CI, 0.91-1.07).

Moreover, a modest increased risk for cSCC was associated with increasing numbers of prescriptions for photosensitizing ADs: 1 to 7 AD prescriptions: aHR 1.12; 95% CI, 1.02-1.24; 8 to 15 AD prescriptions: aHR 1.19; 95% CI, 1.06-1.34; and ≥16 AD prescriptions: aHR 1.41; 95% CI, 1.20-1.67.

The investigators concluded that additional studies, including those that control for such possible confounding factors as sun exposure, are warranted to confirm these findings and further evaluate the risk for cSCC linked with specific classes of drugs.

Reference

Su KA, Habel LA, Achacoso NS, Friedman GD, Asgari MM. Photosensitizing antihypertensive drug use and risk of cutaneous squamous cell carcinoma [published online May 3, 2018]. Br J Dermatol. doi: 10.1111/bjd.16713