Background Patients (pts) with RA are at increased risk for some malignancies and the use of biologic (b)DMARDs has been reported to further increase this risk.1 Abatacept (ABA), the first selective T-cell co-stimulation modulator for RA treatment, is now often prescribed as a first-line bDMARD, but long-term effects are unknown.
Objectives To assess in a real-world, observational study whether treatment with ABA had a similar malignancy risk as other biologics, with or without MTX, when used as the initial bDMARD for RA.
Methods The Truven MarketScan® Commercial and Supplemental Medicare databases were used to identify adult pts diagnosed with RA who initiated bDMARD treatment with ABA or another bDMARD between Jan 2007 and Dec 2014. Other bDMARDs included adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab and tocilizumab. Pts were required to have ≥6 months (M) of continuous health plan enrolment before bDMARD initiation (index date) and deemed to have initiated a treatment if there was no claim for any bDMARD in the limited 6M period before bDMARD initiation. Pts who had a malignancy in the baseline 6M period were excluded. Pts were followed up from the date of the first bDMARD prescription initiation, either ABA or another bDMARD, until occurrence of a malignancy (identified by ICD-9 diagnosis code), end of enrolment in the database or end of data collection, whichever occurred first. A 6M latency period was included. Propensity scores of ABA initiation were estimated from the baseline covariates using a logistic regression model, and trimmed to include only pts with ranges common to both ABA-exposed and comparator bDMARD cohorts. The Cox proportional hazard regression model was used to provide an estimate of the hazard ratio (HR) of malignancy associated with ABA initiation compared with initiation of another bDMARD, adjusted for age and deciles of the propensity score after trimming.
Results A total of 5391 pts were identified as above as having initiated bDMARD therapy with ABA and 74,315 initiated with another bDMARD, with follow-up of <8 yrs (mean 2.1 yrs). Pts who initiated ABA vs other bDMARDs were older (mean 55 vs 52 yrs), had more co-morbidity, used less MTX (49 vs 57%) and more other non-bDMARD (41 vs 36%) at baseline. After trimming on propensity scores, 565 pts developed a malignancy after ABA (incidence rate 5.0 per 100/yr) compared with 5750 after another bDMARD (incidence rate 3.6 per 100/yr). The adjusted HR (95% CI) of any malignancy with ABA initiation relative to other bDMARDs was 1.18 (1.06, 1.30), while for any malignancy excluding non-melanoma skin cancer it was 1.17 (1.02, 1.34). The risk (HR; 95% CI) was not significantly elevated for lung cancer (1.11; 0.70, 1.76), female breast cancer (1.21; 0.91, 1.62) and lymphoma (1.21; 0.77, 1.90).
Conclusions In this large, real-world study of pts treated for RA, the incidence of the most common malignancies of breast, lung and lymphoma were not significantly increased in pts using abatacept as first-line bDMARD treatment compared with other bDMARDs, though the confidence intervals were wide. The slight increase in the risk of overall malignancy with abatacept needs further investigation, particularly to assess the potential for residual confounding and the impact of the short baseline period.
Mercer LK, et al. Ann Rheum Dis 2015;74:1087–93.
Disclosure of Interest S. Suissa Consultant for: Bristol-Myers Squibb, S. Dell'Aniello: None declared, T. Simon Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb