No Evidence of Increased Cancer Incidence in Children Using Topical Tacrolimus for Atopic Dermatitis

J Am Acad Dermatol. 2020 Apr 1;S0190-9622(20)30498-9. doi: 10.1016/j.jaad.2020.03.075. Online ahead of print.


Background: Long-term safety of topical calcineurin inhibitors is not well understood. APPLES (A Prospective Pediatric Longitudinal Evaluation to Assess the Long-Term Safety of Tacrolimus Ointment for the Treatment of Atopic Dermatitis; NCT00475605) examined incidence of lymphoma and other cancers in a pediatric population with atopic dermatitis.

Objective: To quantify incident malignancies during 10 years in children with atopic dermatitis who used topical tacrolimus for ≥6 weeks.

Methods: Standardized incidence ratios for cancer events were analyzed relative to sex-, age-, and race-matched control data from national cancer registries.

Results: There were 7954 eligible patients enrolled at 314 sites in 9 countries. During 44,629 person-years, 6 confirmed incident cancers occurred (standardized incidence ratio, 1.01; 95% confidence interval, 0.37-2.20). No lymphomas occurred.

Limitations: Observational prospective cohort study.

Conclusion: The cancer incidence was as expected, given matched background data. This finding provides no support for the hypothesis that topical tacrolimus increases long-term cancer risk in children with atopic dermatitis.

Keywords: atopic dermatitis; cancer risk; lymphoma; skin cancer; tacrolimus; topical calcineurin inhibitors.