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Rezaeianzadeh, Ramin

University of British Columbia

Background: Estrogen-positive breast cancer (BC) makes up to 75% of all BC patients. With aromatase inhibitors (AIs) and tamoxifen considered mainstay therapies, several small cross-sectional studies have found an association between AI use and ocular adverse events, including dry eye disease (DED), but data on a head-to-head comparison between AIs and tamoxifen are scant. In this study we aim to quantify DED risk in women with BC taking AIs, compared to tamoxifen users. Methods: The IQVIA health claims database was the main data source. This database captures medical diagnoses, procedures, prescriptions, and demographic data on approximately 200 million United States residents. Using a retrospective, new-user, cohort design we identified all users of AIs or tamoxifen, from 2006 to 2020. Cohort members were followed to the first mutually exclusive outcome of DED defined by the first ICD 9th or 10th edition code or the use of a drug that is exclusively used to treat DED. Cox regression was used to estimate hazard ratios (HR), adjusting for confounders and risk factors. Subsequent analyses were conducted to test robustness of findings. Results: Our study included 6,177 and 4,239 patients taking AIs and tamoxifen, respectively. AI users had a mean age of 61.5 (± 16.8 years), whereas tamoxifen users had a mean age of 54.6 (± 12.6 years). The mean follow-up time was 17.5 months. The crude HR for DED with AI use was 1.41(95%CI: 1.07-1.86), compared to tamoxifen use. The adjusted HR for DED was 1.23(95%CI: 0.92-1.64). We found a positive duration response with AI use compared to tamoxifen use, with an adjusted HR for exposure of less than 6 months, 6-18 months, more than 18 months of, 1.34(0.91-1.97), 1.68(1.01-2.78), 1.77(0.82-3.83), respectively. Lastly, for participants older than 55, the HR was 1.07(95% CI:0.74-1.54), while for participants 55 or younger, the HR was 1.43(95% CI:0.88-2.31). Conclusion: Our study demonstrated an increased risk of DED among AI users compared to tamoxifen, although the estimates were mostly not precise. Given that most women with BC are either on AIs or tamoxifen, these findings need to be used for a more personalized risk-benefit assessment for each patient.

Text

2024-04-29

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/88052

Experimental Medicine

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/