Use of certain biologics or disease modifying antirheumatic drugs may be associated with cancer risk

1. The use of rituximab, abatacept and Janus kinase inhibitors (JAKis) in individuals with rheumatoid arthritis (RA) was associated with a statistically significant higher risk of cancer incidence compared to the use of tumour necrosis factor inhibitors (TNFis).

Evidence Rating Level: 2 (Good)

In recent years, safety concerns have been raised over the continued use of JAKis in patients with RA, as one trial reported a higher incidence of cancer associatd with the use of tofacitinib compared to TNFis. Similar studies were conducted since then, but are limited in their generalizability to patients in the United States. This retrospective cohort study therefore sought to investigate the comparative safety of TNFis, non-TNFis and JAKis in RA patients living in the United States. Between November 2012 and December 2021, patients aged 18 to 64 with RA were identified using the Merative Marketscan Research Databases. The primary outcome of interest was any incident cancer, which was attributed to the most recent biologic or synthetic DMARD exposure. A total of 25,305 patients (median age[IQR], 50[42-56] years; 79% female) were included in the study. Rituximab exposure was associated with the highest incidence rate of any cancer compared to all other groups (171 [95% CI, 94-285] cancer diagnoses per 10 000 person-years), while TNFis were associated with the lowest incidence rate (78 [95% CI, 66-91] diagnoses per 10 000 person-years). Based on multiavariate Cox proportional hazards regression analysis, rituximab was associated with a higher risk of incident cancer compared with TNFis (HR, 1.91; 95% CI, 1.17-3.14), followed by abatacept (HR, 1.47; 95% CI, 1.03-2.11) and JAKis (HR, 1.36; 95% CI, 0.94-1.96). Overall, this study found that the use of rituximab, abatacept and JAKis in RA patients living in the United States was associated with an increased risk of any incident cancer compared to the use of TNFis. 

Click to read the study in JAMA Network Open

Image: PD

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