Background: The tolerance of targeted biologic therapies (bDMARDs) used in rheumatoid arthritis (RA) has been studied in patients with no history of cancer. A 5-year cancer remission is recommended to initiate treatment with bDMARDs. However, in the context of the aging of the population and the increase in screening for neoplasia, the question of targeted treatment in a patient with RA with a history of cancer is usual.
Objectives: To determine the risk of recurrence or a new malignancy when exposed to a b-DMARDs in adults with RA and a history of cancer.
Methods: A systematic literature search of EMBASE, MEDLINE, Cochrane Library, and electronic abstract databases of the annual scientific meetings of both the European League Against Rheumatism and the American College of Rheumatology was conducted through June 2019 and selected all cohort follow-up studies including adults with RA with a history of cancer and treated with b-DMARDs (TNF inhibitors, rituximab, abatacept and tocilizumab). We compared the risk of relapse or new cancer onset between the groups treated with and without b-DMARDs. The RevMan 5.3 software was used to calculate the cumulative risks from each group’s Hazard Ratio (HR), with their 95% confidence intervals. The heterogeneity of the studies was evaluated by the Cochran Q test and expressed with the I2 value.
Results: 26 observational cohort studies were selected, of which 12 were included in the meta-analysis. The overall risk of new cancer or recurrence of neoplasia in RA patients with a history of cancer, compared to control subjects, for all b-DMARDs combined was 1.09 (p=0.29, 95%CI [0.92-1.32], I2=16%). The risk of relapse or new cancer onset in patients exposed to TNF inhibitors was 1.11 (p=0.45, 95%CI [0.85-1.46], I2=48%) and 0.79 (p=0.49, 95%CI [0.41-1.53], I2=10%) for rituximab. The rate of recurrence was 1.32 (p=0.04, 95%CI [1.02-1.72], I2=0%) for skin cancer, 1.28 (p=0.07, 95%CI [0.98-1.67], I2=0%) for skin cancers excluding melanoma and 1.21 (p=0.31, 95%CI [0.84-1.72], I2=0%) for breast neoplasia.
Conclusion: This is the first meta-analysis evaluating the risk of recurrence or new cancers in a RA population with a history of neoplasia exposed to b-DMARD. For patients with a history of cancer, for whom the benefit / risk balance has been found to be favorable, the initiation of b-DMARD treatment for RA does not seem to significantly increase the risk of recurrence or new cancer compared to patients naïve to biological treatments, apart from skin cancers including melanoma.
Disclosure of Interests: Amélie Wetzman: None declared, Thomas Barnetche: None declared, Cédric Lukas: None declared, Cecile Gaujoux-Viala: None declared, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Jacques Morel: None declared, Paulina Szafors: None declared
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