Supplementary Material for: Association of non-melanoma skin cancers, melanoma and merkel cell carcinoma with dermatologic medications, a case control pharmacovigilance study of the FDA Adverse Events Reporting System

Background: Medications used in the treatment of dermatologic conditions have been associated with squamous cell carcinoma (SCC), basal cell carcinoma (BCC), melanoma and Merkel cell carcinoma (MCC). Objective: To examine the relationship between systemic dermatologic medications and skin cancer in the FDA Adverse Event Reporting System (FAERS). Methods: Case control analyses were performed in FAERS from 1968-2021 to examine the reporting odds ratios (ROR) for SCC, BCC, melanoma and MCC. Results: The oral immunosuppressants were all associated with increased ROR of SCC, BCC, melanoma and MCC. Azathioprine had the highest ROR for SCC (34.13, 95%CI 29.07-40.08), BCC (21.15, 95%CI 20.63-25.98) and MCC (44.76, 95%CI 31.52-63.55), while quinacrine and guselkumab had the highest ROR for melanoma (13.14, 95%CI 1.84-93.89 vs. 12.73, 95%CI 10.60-15.30 respectively). The TNF-a inhibitors were associated with an increased ROR for all skin cancers investigated. Conclusions: The oral immunosuppressants and many biologic medications were associated with an increased ROR of skin cancers including TNF-alpha inhibitors (etanercept, adalimumab, infliximab), IL-23 or IL 12/23 inhibitors (ustekinumab, risankizumab), and the CD-20 inhibitor rituximab, but not dupilumab or IL-17 inhibitors.