Systematic Review Assesses the Risk of Cancer in Rheumatoid Arthritis Patients

The results of a systematic review found that the risk of recurrent or new cancer is not increased with the incorporation of biologic disease-modifying anti-rheumatic drugs (bDMARDs) for rheumatoid arthritis (RA) compared with no bDMARDs, apart from skin cancers including melanoma.

This study is the first meta-analysis that evaluated the risk of recurrent or new cancers in patients with chronic inflammatory arthritis (CIA) and a history of neoplasia who were exposed to biologic or targeted synthetic disease-modifying anti-rheumatic drugs.

The Motivation

Biologic disease-modifying anti-rheumatic drugs have positively changed the treatment of rheumatoid arthritis by achieving remission and improving quality of life. After this success, these treatments were utilized in the treatment of other chronic inflammatory arthritis diseases including axial spondyloarthritis (AS) and psoriatic arthritis (PsA).

Targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs) emerged as a new therapeutic class within recent years.

Compared with the general population, rheumatoid arthritis patients have displayed an increased risk of cancer, especially for lymphomas and lung cancer. Since biologic disease-modifying anti-rheumatic drugs interfere with the immune system, there was concern that these treatments increased the risk of cancer in this population.

However, according to safety data for biologic disease-modifying anti-rheumatic drugs there’s no evidence of increased risk in patients with rheumatoid arthritis without a history of cancer.

The Study

A team of investigators including Amélie Wetzman, MBBS, Department of Rheumatology, Montpellier University Hospital, University of Montpellier-Nimes, conducted a systematic search of literature that examined adults with rheumatoid arthritis, axial spondyloarthritis, or psoriatic arthritis who had a history of cancer.

Investigators also checked that patients had received biologic or targeted synthetic disease-modifying anti-rheumatic drugs for the assessment. Then they looked at the risk of relapse or occurrence of new cancer in patients who were treated with biologic disease-modifying anti-rheumatic drugs compared with patients who weren’t.

The Cochran Q test and the I² statistic were used to evaluate the heterogeneity of the studies.

A total of 24 observational studies of chronic inflammatory arthritis were included. The included articles were published up to June 2019. In addition, 12 studies were used in the meta-analysis of rheumatoid arthritis patients who received biologic disease-modifying anti-rheumatic drugs.

The Results

The results suggest that risk of recurrent or new cancer is not increased for rheumatoid arthritis patients who have a history of cancer (solid, hemopathy, cervical intra-epithelial neoplasia, non-melanoma skin cancers) and initiating treatment with biologic disease-modifying anti-rheumatic drugs as compared with patients not receiving bDMARDs.

When compared to the control group, the risk of recurrent or new cancer was not increased for rheumatoid arthritis patients with prior cancer and receiving a tumor necrosis factor (TNF) inhibitor or rituximab.

As for skin cancer, the risk of relapse or new cancer was increased for rheumatoid arthritis patients with a history of malignancy, apart from skin cancers excluding melanoma. For melanomas, investigators stated that the results didn’t allow for conclusions because of the small number of included studies.

“For other cancers, cancer in remission and CIA with high activity, initiation of bDMARDs may be considered without increasing the risk of recurrence or a second cancer,” investigators said.

The study, “Risk of Cancer after Initiation of Targeted Therapies in Patients with Rheumatoid Arthritis and a Prior Cancer: Systematic Review with Meta-Analysis”, was published in Arthritis Care & Research.