A RECENT cohort study has raised important questions about the cancer risk associated with biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA). Researchers evaluated data from over 25,000 U.S. patients to compare cancer risks associated with tumor necrosis factor inhibitors (TNFis), non-TNFis, and Janus kinase inhibitors (JAKis). Their findings spotlight potential differences in cancer incidence depending on treatment type.
The study found that patients initiating rituximab, abatacept, or JAKis had a higher risk of developing cancer, excluding nonmelanoma skin cancers, compared to those starting on TNFis. Rituximab showed the highest associated risk (hazard ratio [HR], 1.91), followed by abatacept (HR, 1.47) and JAKis (HR, 1.36). The analysis also suggested that factors like higher disease burden and channeling bias, where patients with more severe disease are directed toward certain treatments, may contribute to these findings rather than the drugs themselves.
The research included 25,305 RA patients aged 18 to 64, predominantly female, with a median age of 50 years. The study observed these individuals for up to two years after starting biologic or targeted synthetic DMARDs, reflecting real-world treatment practices.
While the study underscores the need for larger and longer-term investigations to clarify these risks, it also reinforces the importance of careful clinical decision-making. Healthcare professionals are encouraged to weigh potential cancer risks against the therapeutic benefits of biologics, particularly in patients with a history of cancer or other risk factors.
This study adds to the growing body of evidence on the safety profiles of biologic and targeted therapies, urging ongoing research to better understand the long-term implications of these treatments in managing rheumatoid arthritis.
Aleksandra Zurowska, EMJ
Reference
Sendaydiego X et al. Use of Biologic or Targeted Synthetic Disease-Modifying Antirheumatic Drugs and Cancer Risk. JAMA Netw Open. 2024;7(11):e2446336.
