RA Drugs Do Not Increase Cancer Risk : JAMA

In a register-based cohort study it was found that Short- to medium-term use of tocilizumab, abatacept, rituximab, or anti-TNF drugs seems to be safe with regard to risks of incidence of cancer in patients of Rheumatoid Arthritis. The overall risk of cancer in patients with rheumatoid arthritis did not differ between patients treated with a first anti-TNF drug, a second anti-TNF drug, tocilizumab, abatacept, rituximab, or conventional synthetic disease-modifying antirheumatic drugs.

Hjalmar Wadström et al. in a Cohort Study investigated whether treatment with tocilizumab, abatacept, rituximab, or tumor necrosis factor (TNF) inhibitors affect the risk of malignant neoplasms among patients with rheumatoid arthritis. The researchers considered the fact that there was a widespread and increasing use of biological immunomodulators (biological disease-modifying antirheumatic drugs [bDMARDs]) to treat chronic inflammatory conditions, and the concern that immunomodulation may alter cancer risk and progression, the limited available data on use of these therapies as used in clinical practice and cancer risks are a concern.

The aim of study was to assess the risk of incident malignant neoplasms in patients with rheumatoid arthritis (RA) treated with bDMARDs.

In the study five outcomes were assessed separately:

• A first invasive solid or hematologic malignant neoplasm, excluding nonmelanoma skin cancer (NMSC)


• A first invasive solid malignant neoplasm, excluding NMSC


• A first invasive hematologic malignant neoplasm


• A first invasive squamous cell skin cancer


• A first invasive melanoma

A total of 7405 initiations of other bDMARDs and 46 610 csDMARD users we were identified. The mean age varied from 58 to 64 years, and the proportion of female patients varied from 71% to 80%, across the 7 cohorts under study. The observed numbers of events (crude incidence per 100 000 person-years) for a first invasive solid or hematologic malignant neoplasm were 50 (959) for tocilizumab, 61 (1026) for abatacept, 141 (1074) for rituximab, 478 (978) for initiators of TNFi as first bDMARD, and 169 (917) for TNFi as second bDMARD. There were no statistically significant differences between initiators of a first or second TNFi, or other bDMARDs, and bDMARD-naive RA for any of a total of 25 drug- and outcome-specific comparisons, with 1 exception (abatacept and increased risk of squamous cell skin cancer).

It was concluded that the overall risk of cancer among patients with RA initiating TNFi as first or second bDMARD, tocilizumab, abatacept, or rituximab does not differ substantially from that of biologic drug–naive, csDMARD-treated patients with RA, although altered risks for specific cancer types, or those with longer latency, cannot be excluded.

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http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2653449