Cancer in patients with RA receiving TNF inhibitors or rituximab with prior malignancy

What is it about?

The aim of this study was to explore the influence of TNF inhibitor (TNFi) therapy and rituximab upon the incidence of cancer in patients with RA and prior malignancy. The study population comprised RA subjects with a prior malignancy reported to the UK national cancer registers, recruited to the British Society for Rheumatology Biologics Register from 2001 to 2013. We compared rates of first incident malignancy in a TNFi cohort, rituximab cohort and synthetic DMARDs (sDMARD) cohort. We identified 425 patients with a prior malignancy from 18000 RA patients in the study. Of these, 101 patients developed a new malignancy. The rates of incident malignancy were 33 events per 1000 person-years in the TNFi cohort, 25 events per 1000 person-years in the rituximab cohort, and 54 events per 1000 person-years in the sDMARD cohort. The age- and gender-adjusted hazard ratio was 0.55 (95% CI: 0.35, 0.86) for the TNFi cohort and 0.43 (95% CI: 0.10, 1.80) for the rituximab cohort in comparison with the sDMARDs cohort. The 17% of patients in the sDMARDs cohort had a recurrence of the same cancer in comparison with the 13% and the 4% in the TNFi and rituximab cohorts, respectively.

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Why is it important?

Although numbers are still low, it seems that patients with RA and prior malignancy selected to receive either a TNFi or rituximab in the UK do not have an increased risk of future incident malignancy. Patients with prior malignancy selected to receive biologics do not have an increased risk of incident malignancy. The time between past cancer and first biologic was shorter among rituximab than TNFi patients. It remains unknown whether biologics can be used safely in all patients with prior malignancy.

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