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Utilization of biologic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis and cancer

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Abstract

Introduction

Biologic disease–modifying anti-rheumatic drugs (bDMARDs) interfere with the immune system and could theoretically increase risk of malignancies. However, recent evidence has not substantiated such concerns and physicians are less reluctant in treating patients with underlying cancer with such bDMARDs. We aimed to understand the current utilization patterns of bDMARDs for the treatment of rheumatoid arthritis (RA) in cancer patients.

Methods

We performed a retrospective cohort study of patients with prevalent RA and cancer initially seen at MD Anderson Cancer Center between 2002 and 2014. A cohort of cancer patients was identified from the tumor registry, and patients with RA were identified through ICD-9 codes, followed by review of electronic medical records. We included patients 18 years and older, with a cancer diagnosis, and a diagnosis of RA by a rheumatologist. Patients were followed until 2016.

Results

We identified 431 patients with RA and cancer that met our inclusion criteria. Overall, 111 (26%) received bDMARDs after their cancer diagnosis; of these, 60 (54%) had received bDMARDs prior to their cancer diagnosis and continued to receive this therapy following their diagnosis. Thirteen (22%) switched to a different bDMARD, and the rest continued to receive the same agent after their cancer diagnosis. Of all patients on a bDMARD, 91 (82%) received tumor necrosis factor inhibitors (TNFi).

Conclusions

The treatment landscape of patients with a history of cancer and RA is changing. Future studies evaluating the safety of bDMARDs in patients with a recent history of cancer or with active cancer are needed.

Prior abstract publication

Part of the data of this project was presented as a poster at the 2016 American College of Rheumatology annual meeting.

Zamora NV, Siddhanamatha H, Barbo A, Tayar J, Lin H, Suarez-Almazor M. Utilization of Biologic Therapy in Patients with Rheumatoid Arthritis and Cancer [abstract].Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/utilization-of-biologic-therapy-in-patients-with-rheumatoid-arthritis-and-cancer/. Accessed September 30, 2019.

Key Points

• One in four patients with RA and concomitant cancer received bDMARDs, including TNFi, after their cancer diagnosis, at our institution.

• Half of the patients with RA and cancer who received bDMARDs had initiated therapy prior to the cancer diagnosis, continuing thereafter.

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Funding

This research was supported by the Advancing Science through Pfizer–Investigator Research Exchange program, a competitive grants program supported by Pfizer, to Maria E. Suarez-Almazor. Pfizer ASPIRE Rheumatology award #WI195021. The statistical analysis was supported in part by the Cancer Center Support Grant (NCI Grant P30 CA016672).

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Authors and Affiliations

  1. Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Xerxes Pundole, Jean Tayar & Maria E. Suarez-Almazor

  2. Sección Reumatología, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina

    Natalia V. Zamora

  3. Department of Data Integrity and Analytics, Augusta University Medical Center, Augusta, Georgia

    Harish Siddhanamatha

  4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Heather Lin, Leung Cheuk Hong & Liang Li

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  1. Xerxes Pundole
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  3. Harish Siddhanamatha
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  4. Heather Lin
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  5. Jean Tayar
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  8. Maria E. Suarez-Almazor
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Corresponding author

Correspondence to Maria E. Suarez-Almazor.

Ethics declarations

Institutional review board approval was obtained before any data were collected for this study. The use of patient information complied with the Health Insurance Portability and Accountability Act, and sensitive patient data were protected in the data analysis.

Conflict of interest

Xerxes Pundole—none

Natalia V. Zamora—none

Harish Siddhanamatha—none

Heather Lin—none

Jean Tayar—none

Leung Cheuk Hong—none

Liang Li—none

Maria E. Suarez-Almazor – Dr. Suarez-Almazor has been a consultant for Pfizer, AbbVie and Agile Pharmaceuticals

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Pundole, X., Zamora, N.V., Siddhanamatha, H. et al. Utilization of biologic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis and cancer. Clin Rheumatol 39, 787–794 (2020). https://doi.org/10.1007/s10067-019-04874-x

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  • DOI: https://doi.org/10.1007/s10067-019-04874-x

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