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Observational Study
. 2022 May 5;61(5):1810-1818.
doi: 10.1093/rheumatology/keab570.

Short- and longer-term cancer risks with biologic and targeted synthetic disease-modifying antirheumatic drugs as used against rheumatoid arthritis in clinical practice

Viking Huss  1   2 , Hannah Bower  1 , Hjalmar Wadström  1 , Thomas Frisell  1 , Johan Askling  1   2 ; ARTIS group
Collaborators, Affiliations
Observational Study

Short- and longer-term cancer risks with biologic and targeted synthetic disease-modifying antirheumatic drugs as used against rheumatoid arthritis in clinical practice

Viking Huss et al. Rheumatology (Oxford). .

Abstract

Objective: To estimate the occurrence and relative risks of first-ever-incident non-cutaneous cancer overall and for 16 sites in patients with RA treated with biologic and targeted synthetic DMARDs (b/tsDMARDs), by time since treatment start, attained age, and duration of active treatment.

Methods: This is an observational nationwide and population-based cohort study of patients with RA (n = 69 308), treated with TNF inhibitors (TNFi; adalimumab, certolizumab, etanercept, golimumab, infliximab) or other b/tsDMARDs (abatacept, rituximab, baricitinib, tofacitinib and tocilizumab) compared with RA patients not treated with b/tsDMARDs, and matched general population referents (n = 109 532), 2001-2018. The study was based on prospectively collected data from the Swedish Rheumatology Quality Register and from other registers, linked to the national Swedish Cancer Register. Incidence rates and hazard ratios were estimated via Cox regression adjusted for co-morbidities and other health characteristics.

Results: Based on 8633 incident cancers among RA patients, the overall relative risk of cancer with TNFi [hazard ratio (HR) = 1.0] was neither increased nor did it change with time since treatment start, duration of active treatment, or attained age, when compared with b/tsDMARD-naïve RA. For other b/tsDMARDs, we noted no consistent signal of increased overall risks (HRs ranged from 1.0 to 1.2), but there were statistically significant estimates above 1 for abatacept with 2-5 years of active treatment, for older age groups, and between several of the bDMARDs and urinary tract cancer.

Conclusion: TNFis, as used long term in clinical practice against RA, are not linked to increased risks for cancer overall. For other b/tsDMARDs, and for site-specific risks, our results are generally reassuring but contain signals that call for replication.

Keywords: Sweden; b/tsDMARD; cancer; cohort; register; rheumatoid arthritis.

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Figures

<sc>Fig</sc>. 1
Fig. 1
Relative risks for cancer overall in RA, by bDMARD treatment status (A) In each of the RA treatment cohorts vs. the general population. (B) In bDMARD-treated RA vs. bDMARD-naïve RA. TNFi: TNF inhibitor; b/tsDMARD: biologic and targeted synthetic DMARD.
<sc>Fig</sc>. 2
Fig. 2
Relative risks for cancer overall in bDMARD treated RA vs. bDMARD naïve RA, stratified by time and attained age (A) By time since treatment start (years). (B) By time on active treatment (years). (C) By attained age. TNFi: TNF inhibitor; b/tsDMARD: biologic and targeted synthetic DMARD.
<sc>Fig</sc>. 3
Fig. 3
Site-specific relative risks for cancer with bDMARD-treated vs bDMARD-naïve RA TNFi: TNF inhibitor.
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