Voriconazole exposure and risk of cutaneous squamous cell carcinoma among lung or hematopoietic cell transplant patients: A systematic review and meta-analysis

Published:August 18, 2018DOI:https://doi.org/10.1016/j.jaad.2018.08.010

      Background

      Current evidence about the association between voriconazole and risk of cutaneous squamous cell carcinoma (SCC) remains inconsistent.

      Objective

      To assess the association between voriconazole use and risk of SCC.

      Methods

      We systematically searched PubMed and Embase and performed a random effects model meta-analysis to calculate the pooled relative risk (RR) with a 95% confidence interval (CI).

      Results

      Of the 8 studies involving a total of 3710 individuals with a lung transplant or hematopoietic cell transplant that were included in the qualitative analysis, 5 were included in the meta-analysis. Use of voriconazole was significantly associated with increased risk of SCC (RR, 1.86; 95% CI, 1.36-2.55). The increased risk did not differ according to type of transplantation or adjustment for sun exposure. Longer duration of voriconazole use was found to be positively associated with risk of SCC (RR, 1.72; 95% CI, 1.09-2.72). Voriconazole use was not associated with increased risk of basal cell carcinoma (RR, 0.84; 95% CI, 0.41-1.71).

      Limitations

      There were some heterogeneities in the retrospective observational studies.

      Conclusions

      Our findings support an increased risk of SCC associated with voriconazole in individuals with a lung transplant or hematopoietic cell transplant. Routine dermatologic surveillance should be performed, especially among individuals at high risk of developing SCC.

      Key words

      Abbreviations used:

      BCC ( basal cell carcinoma), CI ( confidence interval), HCT ( hematopoietic cell transplant), LT ( lung transplant), NMSC ( nonmelanoma skin cancer), RR ( relative risk), SCC ( squamous cell carcinoma), UV ( ultraviolet), VNO ( voriconazole N-oxide)
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