No increased cancer risk in patients with rheumatic diseases and prior malignancy treated with novel therapies

A cohort study revealed that cancer risk in patients with rheumatic diseases and a history of previous malignancy did not differ significantly based on the type of biological disease-modifying antirheumatic drugs (DMARDs) and targeted synthetic DMARDs exposure. Besides, there was no difference between those under anti-TNF therapy versus other DMARDs.   

More and more patients with rheumatic diseases are treated with novel therapies, including biological and targeted synthetic DMARDs. Though these patients generally have a higher prevalence of comorbidities, including cancer, available robust data on the malignancy risk is limited.

A cohort study including 352 patients investigated the occurrence and relative risk of incident cancer in those with rheumatic diseases and prior malignancy treated with DMARDs [1]. The study selected patients from the multicentre, prospective Spanish BIOBADASER registry (BIOBADASER 3.0). Records from 9,129 rheumatic patients from 2001 to 2021 were analysed.

Dr Juan Molina Collada (Gregorio Marañón General University Hospital, Spain) and his team defined incident cancer as any cancer (new primary tumours, local recurrence, or metastases) occurring during drug exposure classified according to Medical Dictionary for Regulatory Activities (MedDRA) and leading to therapy discontinuation.

The study cohort had a mean age of 65.3 years, 70% were female, and had a mean Charlson comorbidity index of 5.2. Overall, 94% (n=331) of the patients had experienced prior non-lymphoproliferative malignancy (solid or melanoma).

“During the study period, we noted 32 incident malignancies, of which 53% (n=17) were solid cancer and 44% (n=14) were non-melanoma skin cancer, whereas 1 patient developed melanoma,” Dr Collada said. The overall rate of incident malignancy was 27.1 (95% CI 18.6-38.3) events per 1,000 person-years (PY), ranging between 0 events/1,000 PY in the anti-IL17 group to 51.7 events/1,000 PY in the anti-CTLA-4 group.

The overall rate of incident cancer did not differ significantly in patients exposed to JAK inhibitors (0.6; 95% CI 0.1-2.5), anti-CD20 (0.3; 95% CI 0.1-1.4), anti-IL6 (1.2; 95% CI 0.5-3.4), or anti-CTLA-4 (1.3; 95% CI 0.5-3.6) versus anti-TNF therapy. There was also no difference regarding the rate of different types of cancer (melanoma, non-melanoma skin cancer, or solid tumours) between individual treatment groups compared with anti-TNF.

Besides, the mortality rates in patients exposed to JAK inhibitors, anti-CD20, anti-IL6, anti-IL17, or anti-CTLA-4 versus anti-TNF therapy were similar.

The research team concluded that the risk of incident cancer in patients with rheumatic diseases and previous malignancy did not differ according to the type of DMARDs exposure. Additionally, it did not vary substantially in patients exposed to other DMARDs versus anti-TNF treatment. “We should say that we have not found an increased risk of cancer in this population, although we cannot exclude a potential risk,” Dr Collada mentioned. Hence, further long-term registry data is needed to verify these results.

1. 
   
   1. Molina J. Risk of cancer after biologic and targeted synthetic DMARDs initiation in patients with rheumatic diseases and a history of prior malignancy: data from the BIOBADASER registry. 0267, ACR Convergence 2022, 10–14 November, Philadelphia, USA.

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Posted on 1 December 20221 February 2024