Topical pimecrolimus use for atopic dermatitis not linked to malignancy

1. Contrary to previous information, pimecrolimus was not associated with lymphomas or cutaneous malignancies.

Evidence Rating Level: 2 (Good)

Study Rundown: Atopic dermatitis (AD), an inflammatory disease of the skin, necessitates a variety of treatment options due to its high prevalence and possibly severe symptoms. Calcineurin inhibitors are one class of medication that can treat AD. However, some drug members of this family have been associated with increased risk of malignancy as an adverse effect. These authors sought to understand the risk of malignancy associated with pimecrolimus, a calcineurin inhibitor. Authors observed that usage of topical pimecrolimus in the treatment of AD was not associated with increased risk of malignancy. While a large number of participants were statistically analyzed through the Pediatric Eczema Elective Registry (PEER), participants may not have reported side effects due to loss of follow-up; however, the authors attempted to contact this group.

Click to read the study in JAMA Dermatology

Relevant Reading: Topical calcineurin inhibitors and lymphoma risk: evidence update with implications for daily practice

In-Depth [prospective cohort]: This study sought to understand the association between topical use of pimecrolimus in AD and malignancy risk utilizing 7,457 children, a total of 26,792 person years. The PEER was used to identify and to evaluate patients with mild to moderate AD who were between the ages of 2 and 17. Participants had used pimecrolimus cream for at least 6 weeks out of the preceding half year and were contacted every 6 months regarding malignancy after usage of pimecrolimus. Incidence rates of cancer were compared to the Surveillance, Epidemiology and End Results (SEER) program rates. Authors found that five malignancies (2 leukemias, 1 osteosarcoma, and 2 lymphomas) had been reported. However, the standardized incidence ratio for all malignancies (1.2, 95% CI, 0.5-2.8) as well as the aforementioned malignancies were not statistically significant.

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