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Nesbitt C, Van Der Walt A, Butzkueven H, Devitt B, Jokubaitis VG. Multiple sclerosis and cancer: Navigating a dual diagnosis. Mult Scler 2024:13524585241274523. [PMID: 39347791 DOI: 10.1177/13524585241274523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Healthcare breakthroughs are extending the lives of multiple sclerosis (MS) patients and cancer survivors, creating a growing cohort of individuals navigating a dual diagnosis. Determining the relationship between MS and cancer risk remains challenging, with inconclusive findings confounded by age, risk exposures, comorbidities, genetics and the ongoing introduction of new MS disease-modifying therapies (DMTs) across study periods.This research places significant emphasis on cancer survival, with less attention given to the impact on MS outcomes. Our review explores the existing literature on MS, cancer risk and the intersection of DMTs and cancer treatments. We aim to navigate the complexities of managing MS in cancer survivors to optimise outcomes for both conditions. Continuous research and the formulation of treatment guidelines are essential for guiding future care. Collaboration between neuro-immunology and oncology is crucial, with a need to establish databases for retrospective and ultimately prospective analysis of outcomes in these rapidly evolving fields.
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Affiliation(s)
- Cassie Nesbitt
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
- Department of Neurology, MSNI Multiple Sclerosis and Neuro-Immunology, Alfred Health, Melbourne, VIC, Australia
- Department of Neuroscience, Monash University, The Alfred Centre, Melbourne, VIC, Australia
| | - Anneke Van Der Walt
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
- Department of Neurology, MSNI Multiple Sclerosis and Neuro-Immunology, Alfred Health, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
- Department of Neurology, MSNI Multiple Sclerosis and Neuro-Immunology, Alfred Health, Melbourne, VIC, Australia
| | - Bianca Devitt
- Department of Oncology, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
- Oncology Clinical Trials Unit, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Vilija G Jokubaitis
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
- Department of Neurology, MSNI Multiple Sclerosis and Neuro-Immunology, Alfred Health, Melbourne, VIC, Australia
- Department of Neuroscience, Monash University, The Alfred Centre, Melbourne, VIC, Australia
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Álvaro-Gracia Álvaro JM, Díaz Del Campo Fontecha P, Andréu Sánchez JL, Balsa Criado A, Cáliz Cáliz R, Castrejón Fernández I, Corominas H, Gómez Puerta JA, Manrique Arija S, Mena Vázquez N, Ortiz García A, Plasencia Rodríguez C, Silva Fernández L, Tornero Molina J. Update of the Consensus Statement of the Spanish Society of Rheumatology on the use of biological and synthetic targeted therapies in rheumatoid arthritis. REUMATOLOGIA CLINICA 2024:S2173-5743(24)00111-4. [PMID: 39341701 DOI: 10.1016/j.reumae.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/24/2024] [Indexed: 10/01/2024]
Abstract
OBJECTIVE To update the consensus document of the Spanish Society of Rheumatology (SER) regarding the use of targeted biological and synthetic therapies in rheumatoid arthritis (RA) with the aim of assisting clinicians in their therapeutic decisions. METHODS A panel of 13 experts was assembled through an open call by SER. We employed a mixed adaptation-elaboration-update methodology starting from the 2015 Consensus Document of the Spanish Society of Rheumatology on the use of biological therapies in RA. Starting with systematic reviews (SR) of recommendations from EULAR 2019, American College of Rheumatology 2021, and GUIPCAR 2017, we updated the search strategies for the PICO questions of GUIPCAR. An additional SR was conducted on demyelinating disease in relation to targeted biological and synthetic therapies. Following the analysis of evidence by different panelists, consensus on the wording and level of agreement for each recommendation was reached in a face-to-face meeting. RESULTS The panel established 5 general principles and 15 recommendations on the management of RA. These encompassed crucial aspects such as the importance of early treatment, therapeutic goals in RA, monitoring frequency, the use of glucocorticoids, the application of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biological DMARDs (bDMARDs), and targeted synthetic DMARDs. Additionally, recommendations on dose reduction of these drugs in stable patients were included. This update also features recommendations on the use of bDMARDs and Janus Kinase inhibitors in some specific clinical situations, such as patients with lung disease, a history of cancer, heart failure, or demyelinating disease. CONCLUSIONS This update provides recommendations on key aspects in the management of RA using targeted biological and synthetic therapies.
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Affiliation(s)
- José María Álvaro-Gracia Álvaro
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, IiSGM, Universidad Complutense Madrid, Madrid, Spain.
| | | | - José Luis Andréu Sánchez
- Servicio de Reumatología, H.U. Puerta de Hierro Majadahonda, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Isabel Castrejón Fernández
- Servicio de Reumatología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital Gregorio Marañón, Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Hèctor Corominas
- Servicio de Reumatología, Hospital Universitari de la Santa Creu i Sant Pau & Hospital Dos de Maig, Barcelona, Spain
| | | | - Sara Manrique Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, UGC de Reumatología, Hospital Regional Universitario de Málaga, Departamento de Medicina, Universidad de Málaga, Málaga, Spain
| | - Natalia Mena Vázquez
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Ana Ortiz García
- Servicio de Reumatología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Lucía Silva Fernández
- Servicio de Reumatología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Jesús Tornero Molina
- Servicio de Reumatología, Hospital Universitario de Guadalajara, Departamento de Medicina, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
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Suarez-Almazor ME, Ruiz JI, Lei X, Wu CF, Zhao H, Rajan SS, Giordano SH. Trends in the use of biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis and recently diagnosed colorectal, lung, or prostate cancer. Clin Rheumatol 2024:10.1007/s10067-024-07135-8. [PMID: 39230743 DOI: 10.1007/s10067-024-07135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/29/2024] [Accepted: 08/31/2024] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Biologic disease-modifying antirheumatic drugs (bDMARD) are often discontinued when a patient with rheumatoid arthritis (RA) is diagnosed with cancer. Our aim was to determine trends in bDMARD utilization in patients with RA and recently diagnosed cancer. METHOD We examined two national claims databases to identify adults with RA and recently diagnosed colorectal, lung, or prostate cancer (Optum's de-identified Clinformatics® Data Mart Database 2008-2022, and Surveillance, Epidemiology, and End Results Program (SEER) Medicare-linked 2008-2017). We determined time trends in bDMARD and tumor necrosis factor inhibitor (TNFi) prescriptions during the first 3 years after cancer with Cochram-Armitage tests and multivariable logistic regression. Cancer cohorts were analyzed separately. RESULTS We included 3595 patients in all six cohorts (in Clinformatics® 503 with colorectal, 468 with lung, and 440 with prostate cancer; in SEER-Medicare 580 with colorectal, 1010 with lung, and 594 with prostate cancer). No significant increase was observed in bDMARD or TNFi utilization over time. Overall, use of bDMARD within the first 3 years of follow-up ranged from 16.7% (Clinformatics® lung cohort) to 29.7% (SEER-Medicare colorectal cohort). The major predictor of bDMARD utilization was prior use in the 3 months before cancer diagnosis (p < 0.001 for all cancers) and earlier cancer stage (p < 0.001 in colorectal and lung cancer and p = 0.05 in prostate cancer). CONCLUSIONS Use of bDMARD in patients with RA and recently diagnosed common cancers has not increased since 2008. Additional evidence on the safety of bDMARD in patients with early cancer is needed to ensure appropriate management of their RA. Key Points • Use of bDMARD and TNFi in patients with RA and early colorectal, lung, or prostate cancer has been stable since 2008, with no significant increases over time. • The major determinant of receiving bDMARD after cancer diagnosis was prior treatment with bDMARD in the prior 3 months before cancer. • Patients with advanced cancer stage and distant metastases were less likely to receive bDMARD and TNFi than those at early stages of disease.
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Affiliation(s)
- Maria E Suarez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1444, Houston, TX, 77030, USA.
| | - Juan I Ruiz
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1444, Houston, TX, 77030, USA
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1444, Houston, TX, 77030, USA
| | - Chi-Fang Wu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1444, Houston, TX, 77030, USA
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1444, Houston, TX, 77030, USA
| | - Suja S Rajan
- Department of Management, Policy and Community Heath, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1444, Houston, TX, 77030, USA
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Miyakawa N, Tsuritani K, Teixeira BC, Fujio K. Disease-modifying antirheumatic drug selection in Japanese patients with rheumatoid arthritis treated with biologics or JAK inhibitors without methotrexate: A retrospective hospital-based administrative claims database study. Mod Rheumatol 2024; 34:900-909. [PMID: 38450776 DOI: 10.1093/mr/roae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES We evaluated the medication selection and clinical characteristics of rheumatoid arthritis patients who started treatment with/without methotrexate (MTX) (using biologic disease-modifying antirheumatic drugs or Janus kinase inhibitors instead) in Japan. METHODS Using a Japanese hospital-based administrative claims database, rheumatoid arthritis patients who received treatment [abatacept (ABA), interleukin-6 receptor inhibitor, tumor necrosis factor inhibitor, or Janus kinase inhibitor] between 1 January 2015 and 31 December 2019 were enrolled. RESULTS Overall, 19,301 patients were included (10,530 receiving MTX; 8771 not receiving MTX within 60 days of the first treatment). Mean ages at diagnosis were 60.7 and 65.9 years in the MTX and non-MTX groups, respectively (P < .0001). The non-MTX group had higher proportions of patients with Charlson Comorbidity Index ≥1 (P < .0001) and higher comorbidity rates. ABA was the most frequently used drug among patients with infectious/parasitic, circulatory, and respiratory diseases at baseline. Interleukin-6 receptor inhibitor had the highest use rate among patients with neoplasms; blood, gastrointestinal, and genitourinary diseases; and abnormal clinical/laboratory findings. ABA had the highest persistence probability from 6 months onward. CONCLUSIONS MTX is used less frequently among older Japanese rheumatoid arthritis patients or those with comorbidities. In such patients, ABA is the most frequently used drug, followed by interleukin-6 receptor inhibitor, when MTX is not used at treatment start.
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Affiliation(s)
- Naohisa Miyakawa
- Japan Medical, Innovative Medicine, Bristol Myers Squibb K.K., Tokyo, Japan
| | - Katsuki Tsuritani
- Japan Medical, Innovative Medicine, Bristol Myers Squibb K.K., Tokyo, Japan
| | | | - Keishi Fujio
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Favalli EG, Maioli G, Caporali R. Biologics or Janus Kinase Inhibitors in Rheumatoid Arthritis Patients Who are Insufficient Responders to Conventional Anti-Rheumatic Drugs. Drugs 2024; 84:877-894. [PMID: 38949688 PMCID: PMC11343917 DOI: 10.1007/s40265-024-02059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/02/2024]
Abstract
Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease which can induce progressive disability if not properly treated early. Over the last 20 years, the improvement of knowledge on the pathogenesis of the disease has made available several drugs targeting key elements of the pathogenetic process, which now represent the preferred treatment option after the failure of first-line therapy with conventional drugs such as methotrexate (MTX). To this category of targeted drugs belong anti-cytokine or cell-targeted biological agents and more recently also Janus kinase inhibitors (JAKis). In the absence to date of specific biomarkers to guide the therapeutic choice in the context of true precision medicine, the choice of the first targeted drug after MTX failure is guided by treatment cost (especially after the marketing of biosimilar products) and by the clinical characteristics of the patient (age, sex, comorbidities and compliance) and the disease (presence or absence of autoantibodies and systemic or extra-articular manifestations), which may influence the efficacy and safety profile of the available products. This viewpoint focuses on the decision-making process underlying the personalized approach to RA therapy and will analyse the evidence in the literature supporting the choice of individual products and in particular the differential choice between biological drugs and JAKis.
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Affiliation(s)
- Ennio Giulio Favalli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy
- Department of Rheumatology and Medical Sciences, Gaetano Pini-CTO Hospital, P.zza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Gabriella Maioli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy.
- Department of Rheumatology and Medical Sciences, Gaetano Pini-CTO Hospital, P.zza Cardinal Ferrari 1, 20122, Milan, Italy.
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy
- Department of Rheumatology and Medical Sciences, Gaetano Pini-CTO Hospital, P.zza Cardinal Ferrari 1, 20122, Milan, Italy
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Collongues N, Durand-Dubief F, Lebrun-Frenay C, Audoin B, Ayrignac X, Bensa C, Bigaut K, Bourre B, Carra-Dallière C, Ciron J, Defer G, Kwiatkowski A, Leray E, Maillart E, Marignier R, Mathey G, Morel N, Thouvenot E, Zéphir H, Boucher J, Boutière C, Branger P, Da Silva A, Demortière S, Guillaume M, Hebant B, Januel E, Kerbrat A, Manchon E, Moisset X, Montcuquet A, Pierret C, Pique J, Poupart J, Prunis C, Roux T, Schmitt P, Androdias G, Cohen M. Cancer and multiple sclerosis: 2023 recommendations from the French Multiple Sclerosis Society. Mult Scler 2024; 30:899-924. [PMID: 38357870 DOI: 10.1177/13524585231223880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Epidemiological data reveal that 45% of persons with multiple sclerosis (PwMS) in France are more than 50 years. This population more than 50 is more susceptible to cancer, and this risk may be increased by frequent use of immunosuppressive drugs. Consequently, concerns have arisen about the potential increased risk of cancer in PwMS and how patients should be screened and managed in terms of cancer risk. OBJECTIVE To develop evidence-based recommendations to manage the coexistence of cancer and multiple sclerosis (MS). METHODS The French Group for Recommendations in MS collected articles from PubMed and university databases covering the period January 1975 through June 2022. The RAND/UCLA method was employed to achieve formal consensus. MS experts comprehensively reviewed the full-text articles and developed the initial recommendations. A group of multidisciplinary health care specialists then validated the final proposal. RESULTS Five key questions were addressed, encompassing various topics such as cancer screening before or after initiating a disease-modifying therapy (DMT), appropriate management of MS in the context of cancer, recommended follow-up for cancer in patients receiving a DMT, and the potential reintroduction of a DMT after initial cancer treatment. A strong consensus was reached for all 31 recommendations. CONCLUSION These recommendations propose a strategic approach to managing cancer risk in PwMS.
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Affiliation(s)
- Nicolas Collongues
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
- Center for Clinical Investigation, INSERM U1434, Strasbourg, France
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
- Department of Pharmacology, Addictology, Toxicology, and Therapeutics, Strasbourg University, Strasbourg, France
| | - Françoise Durand-Dubief
- Service de Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Christine Lebrun-Frenay
- Department of Neurology, CHU Nice, Nice, France
- Université Côte d'Azur, UMR2CA-URRIS, Nice, France
| | - Bertrand Audoin
- Department of Neurology, CRMBM, APHM, Aix-Marseille University, Marseille, France
| | - Xavier Ayrignac
- Department of Neurology, Montpellier University Hospital, Montpellier, France
- University of Montpellier, Montpellier, France
- INM, INSERM, Montpellier, France
| | - Caroline Bensa
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Kévin Bigaut
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
| | | | | | - Jonathan Ciron
- CHU de Toulouse, CRC-SEP, Department of Neurology, Toulouse, France
- Université Toulouse III, Infinity, INSERM UMR1291-CNRS UMR5051, Toulouse, France
| | - Gilles Defer
- Department of Neurology, Caen University Hospital, Caen, France
| | - Arnaud Kwiatkowski
- Department of Neurology, Lille Catholic University, Lille Catholic Hospitals, Lille, France
| | - Emmanuelle Leray
- Université de Rennes, EHESP, CNRS, INSERM, ARENES-UMR 6051, RSMS-U1309, Rennes, France
| | | | - Romain Marignier
- Service de Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Guillaume Mathey
- Department of Neurology, Nancy University Hospital, Nancy, France
| | - Nathalie Morel
- Service de Neurologie, Centre Hospitalier Annecy Genevois, Epagny-Metz-Tessy, France
| | - Eric Thouvenot
- Service de Neurologie, CHU de Nîmes, Nîmes, France
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Hélène Zéphir
- University of Lille, INSERM U1172, CHU de Lille, Lille, France
| | - Julie Boucher
- Department of Neurology, CHU de Lille, Lille, France
| | - Clémence Boutière
- Department of Neurology, University Hospital of Marseille, Marseille, France
| | - Pierre Branger
- Service de Neurologie, CHU de Caen Normandie, Caen, France
| | - Angélique Da Silva
- Breast Cancer Unit, Centre François Baclesse, Institut Normand du Sein, Caen, France
| | - Sarah Demortière
- Department of Neurology, CRMBM, APHM, Aix-Marseille University, Marseille, France
| | | | | | - Edouard Januel
- Sorbonne Université, Paris, France/Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Paris, France
- Département de Neurologie, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| | - Anne Kerbrat
- Service de Neurologie, CHU de Rennes, France
- EMPENN U1228, INSERM-INRIA, Rennes, France
| | - Eric Manchon
- Service de Neurologie, Centre Hospitalier de Gonesse, Gonesse, France
| | - Xavier Moisset
- Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM, Neuro-Dol, Clermont-Ferrand, France
| | | | - Chloé Pierret
- Université de Rennes, EHESP, CNRS, INSERM, ARENES-UMR 6051, RSMS U-1309, Rennes, France
| | - Julie Pique
- Service de Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Julien Poupart
- Department of Neurology and U995-LIRIC-Lille Inflammation Research International Center, INSERM, University of Lille, CHU Lille, Lille, France
| | - Chloé Prunis
- Department of Neurology, Nancy University Hospital, Nancy, France
| | - Thomas Roux
- Hôpital La Pitié-Salpêtrière, Service de Neurologie, Paris, France
- CRC-SEP Paris. Centre des maladies inflammatoires rares du cerveau et de la moelle de l'enfant et de l'adulte (Mircem)
| | | | - Géraldine Androdias
- Service de Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Service de Neurologie, Hôpital Neurologique Pierre Wertheimer, Bron, France
- Clinique de la Sauvegarde-Ramsay Santé, Lyon, France
| | - Mikael Cohen
- Department of Neurology, CHU Nice, Nice, France/Université Côte d'Azur, UMR2CA-URRIS, Nice, France
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Sen R, Riofrio M, Singh JA. A narrative review of the comparative safety of disease-modifying anti-rheumatic drugs used for the treatment of rheumatoid arthritis. Expert Opin Drug Saf 2024; 23:687-714. [PMID: 38695151 DOI: 10.1080/14740338.2024.2348575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/24/2024] [Indexed: 05/24/2024]
Abstract
INTRODUCTION Disease-modifying anti-rheumatic drugs (DMARDs) have improved the outcomes of patients with rheumatoid arthritis (RA). DMARDs are classified into three categories: conventional synthetic DMARDs, biological DMARDs (including biosimilars), and targeted synthetic DMARDs. DMARDs, by way of their effect on the immune system, are associated with increased risk of adverse events, including infections, malignancies, cardiovascular disease, gastrointestinal perforations, and other less common events. AREAS COVERED In this narrative literature review performed with searches of the PubMed database from 1 January 2010 through 1 January 2023, we compare the risk of safety events between DMARDs using data from both randomized clinical trials and observational studies. EXPERT OPINION DMARD use in RA is associated with higher rates of serious infections, tuberculosis reactivation, opportunistic infections, and possibly malignancies. Specific biologic DMARDs and higher doses are associated with elevated risks of various adverse events (gastrointestinal perforations, thromboembolism, serious infection). Shared decision-making is paramount when choosing a treatment regimen for patients based on their own comorbidities. JAKi are the newest class of medications used for RA with robust safety data provided in clinical trials. However, more real-world evidence and phase-IV pharmacovigilance data are needed to better understand comparative safety profile of DMARDs in RA.
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Affiliation(s)
- Rouhin Sen
- Division of Clinical Immunology and Rheumatology, The University of Alabama Birmingham, Birmingham, AL, USA
- Medicine/Rheumatology Birmingham Veterans Affairs Medical Center (VAMC), Birmingham, AL, USA
| | - Maria Riofrio
- Division of Clinical Immunology and Rheumatology, The University of Alabama Birmingham, Birmingham, AL, USA
| | - Jasvinder A Singh
- Division of Clinical Immunology and Rheumatology, The University of Alabama Birmingham, Birmingham, AL, USA
- Medicine/Rheumatology Birmingham Veterans Affairs Medical Center (VAMC), Birmingham, AL, USA
- Department of Epidemiology, UAB School of Public Health, Birmingham, AL, USA
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Granger EE, Groover M, Harwood C, Proby CM, Karn E, Murad F, Schmults CD, Ruiz ES. Cutaneous squamous cell carcinoma tumor accrual rates in immunosuppressed patients with autoimmune and inflammatory conditions: A retrospective cohort study. J Am Acad Dermatol 2024; 90:731-738. [PMID: 38043592 DOI: 10.1016/j.jaad.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/29/2023] [Accepted: 11/04/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Immunosuppression is a known risk factor for the development of cutaneous squamous cell carcinoma (CSCC), especially in solid organ transplant recipients and chronic lymphocytic leukemia. However, this risk is less well defined in autoimmune and inflammatory conditions. OBJECTIVE Assess the impact that disease-type, duration of immunosuppression, and systemic medications have on CSCC accrual rates, defined as the number of CSCCs a patient develops per year, in autoimmune and inflammatory conditions. METHODS Retrospective review of 94 immunosuppressed (rheumatoid arthritis: 31[33.0%], inflammatory bowel disease: 17[18.1%], psoriasis: 11[11.7%], autoimmune other (AO): 24[25.5%], inflammatory other: 21[22.3%]) and 188 immunocompetent controls to identify all primary, invasive CSCCs diagnosed from 2010 to 2020. RESULTS Immunosuppressed patients had higher CSCC accrual rates than immunocompetent controls (0.44 ± 0.36): total cohort (0.82 ± 0.95, P < .01), rheumatoid arthritis (0.88 ± 1.10, P < .01), inflammatory bowel disease (0.94 ± 0.88, P < .01), psoriasis (1.06 ± 1.58, P < .01), AO (0.72 ± 0.56, P < .01), and inflammatory other (0.72 ± 0.61, P < .01). There was an association between increased tumor accrual rates and exposure to systemic medications including, immunomodulators, tumor necrosis factor-alpha inhibitors, non-tumor necrosis factor inhibitor biologics, and corticosteroids, but not with number of systemic medication class exposures or duration of immunosuppression. LIMITATIONS Retrospective, singlecenter study. CONCLUSION Patients with autoimmune and inflammatory conditions accrue CSCCs at higher rates than immunocompetent patients.
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Affiliation(s)
- Emily E Granger
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Morgan Groover
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Catherine Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Charlotte M Proby
- Department of Dermatology, Ninewells Hospital, Dundee, United Kingdom
| | - Emily Karn
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fadi Murad
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Fujita S, Nakano K, Nagasu A, Hiramatsu-Asano S, Akagi T, Morita Y. Prognosis and prognostic factors of lung cancer complications in patients with rheumatoid arthritis. Int J Rheum Dis 2024; 27:e15069. [PMID: 38514918 DOI: 10.1111/1756-185x.15069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 03/23/2024]
Abstract
AIM To clarify the prognosis and prognostic factors for lung cancer in patients with rheumatoid arthritis (RA). METHODS In this retrospective longitudinal study, we investigated the medical records of patients with RA among 1422 patients diagnosed with lung cancer and registered in a hospital-based cancer registry between January 2013 and May 2022. The Kaplan-Meier method and Cox proportional hazards model were used to analyze survival and identify predictive factors. RESULTS Of 26 patients with RA complicated with lung cancer (median age, 69 years), the 2-year overall survival rates for stages I-II were 90%-100%, and those for stages III-IV were 20%, respectively. Positivity of anti-citrullinated protein/peptide antibody, smoking history, interstitial lung disease, poorly controlled RA, stage III and IV lung cancer, histological types other than adenocarcinoma and squamous cell carcinoma, and RF ≧ 50 IU/mL were associated with increased mortality. After the surgical resection of stage I and II lung cancer, 5 of the 16 patients experienced cancer recurrence after resumption of RA treatment, and the histology of the recurrent cancers was mostly squamous cell carcinoma. CONCLUSIONS Early detection of lung cancer is needed, especially in patients with RA who have a history of smoking, seropositivity, or interstitial lung disease. Even after surgical resection, it should be noted that squamous cell carcinoma is prone to recurrence.
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MESH Headings
- Humans
- Aged
- Prognosis
- Lung Neoplasms/diagnosis
- Lung Neoplasms/epidemiology
- Lung Neoplasms/complications
- Retrospective Studies
- Longitudinal Studies
- Neoplasm Recurrence, Local/complications
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/diagnosis
- Arthritis, Rheumatoid/epidemiology
- Lung Diseases, Interstitial/diagnosis
- Lung Diseases, Interstitial/epidemiology
- Lung Diseases, Interstitial/etiology
- Anti-Citrullinated Protein Antibodies
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/therapy
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Affiliation(s)
- Shunichi Fujita
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Kazuhisa Nakano
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Akiko Nagasu
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | | | - Takahiko Akagi
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshitaka Morita
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
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Li Y, Wang J, Zhang J, Jiang H, Liu A, Ying Z. When rheumatoid arthritis meets malignancy, what do we do? Int J Rheum Dis 2024; 27:e15095. [PMID: 38439191 DOI: 10.1111/1756-185x.15095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/30/2024] [Accepted: 02/11/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Yixuan Li
- Zhejiang Chinese Medical University, Hangzhou, China
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Jing Wang
- Zhejiang Chinese Medical University, Hangzhou, China
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Ju Zhang
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Huan Jiang
- Zhejiang Chinese Medical University, Hangzhou, China
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Aihui Liu
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, China
| | - Zhenhua Ying
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, China
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11
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Molina-Collada J, Alonso F, Otero L, Bohórquez C, Díaz Torné C, Pérez García C, Blanco Madrigal JM, Vela P, Álvaro-Gracia JM, Castrejón I. Cancer risk with biologic and targeted synthetic DMARDs in patients with rheumatic diseases and previous malignancies: Results from the BIOBADASER register. Semin Arthritis Rheum 2024; 64:152341. [PMID: 38128174 DOI: 10.1016/j.semarthrit.2023.152341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE to investigate the occurrence and relative risk of incident malignancy in patients with rheumatic diseases and previous malignancies treated with biologic and targeted synthetic DMARDs (b/tsDMARDs). METHODS Cohort study of patients included in BIOBADASER 3.0 up to 2021, treated with b/tsDMARDs and history of a previous malignancy. Incident cancer was defined as any cancer (new primary, local recurrence or metastases) during the drug exposure. Incidence rate ratios of cancer per 1,000 patients-year (PY) and 95 % confidence interval (CI) were estimated. Rates of incident cancer in tsDMARDs and other bDMARDs versus TNFi were compared. RESULTS A total of 352 patients from over 9,129 patients recorded in BIOBADASER 3.0 had a history of a previous malignancy. Overall, there were 47 incident malignancies (28 solid cancers, 18 non-melanoma skin cancers and 1 melanoma). The overall rate of incident malignancy was 47.4 (95 % CI 35.6-63.1) events/1,000 PY, ranging between 24.5 events/1000 PY in the anti-CD20 group to 93 events/1000 PY in the anti-CTLA-4 group. We did not find differences in the adjusted rate of incident cancer in patients exposed to JAKi [0.5 (95 % CI 0.2-1.7)], anti-CD20 [0.4(95 % CI 0.1-1)], or anti-IL6 [1.1(95 % CI 0.5-2.4)], anti-CTLA-4 [1.5 (95 % CI 0.7-3.1) or anti-IL17 [0.7 (95 % CI 0.2-2.4) versus TNFi therapy. CONCLUSIONS We did not find differences in the risk of incident cancer in patients with rheumatic diseases and a previous malignancy between TNFi and other b/tsDMARDs. While incident cancers in our cohort were limited, our data is reassuring, awaiting validation in future studies.
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Affiliation(s)
- Juan Molina-Collada
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - Fernando Alonso
- Department of Rheumatology, Unidad de investigación, Sociedad Española de Reumatología, Madrid, Spain
| | - Lucía Otero
- Department of Rheumatology, Unidad de investigación, Sociedad Española de Reumatología, Madrid, Spain
| | - Cristina Bohórquez
- Department of Rheumatology, Hospital Príncipe de Asturias, Madrid, Spain
| | - César Díaz Torné
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario Doctor Balmis, Alicante, Spain; SABIAL, Alicante, Spain
| | - José María Álvaro-Gracia
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Isabel Castrejón
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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12
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Simon TA, Suissa S, Boers M, Hochberg MC, Skovron ML, Askling J, Michaud K, Strangfeld A, Pedro S, Frisell T, Meissner Y, Dominique A, Gomez A. Malignancy outcomes in patients with rheumatoid arthritis treated with abatacept and other disease-modifying antirheumatic drugs: Results from a 10-year international post-marketing study. Semin Arthritis Rheum 2024; 64:152240. [PMID: 37500379 DOI: 10.1016/j.semarthrit.2023.152240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 05/12/2023] [Accepted: 06/25/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To evaluate the risk of malignancy (overall, breast, lung, and lymphoma) in patients with rheumatoid arthritis treated with abatacept, conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs), and other biologic/targeted synthetic (b/ts)DMARDs in clinical practice. METHODS Four international observational data sources were included: ARTIS (Sweden), RABBIT (Germany), FORWARD (USA), and BC (Canada). Crude incidence rates (IRs) per 1000 patient-years of exposure with 95% confidence intervals (CIs) for a malignancy event were calculated; rate ratios (RRs) were estimated and adjusted for demographics, comorbidities, and other potential confounders. RRs were then pooled in a random-effects model. RESULTS Across data sources, mean follow-up for patients treated with abatacept (n = 5182), csDMARDs (n = 73,755), and other b/tsDMARDs (n = 37,195) was 3.0-3.7, 2.9-6.2, and 3.1-4.7 years, respectively. IRs per 1000 patient-years for overall malignancy ranged from 7.6-11.4 (abatacept), 8.6-13.2 (csDMARDs), and 5.0-11.8 (other b/tsDMARDs). IRs ranged from: 0-4.4, 0-3.3, and 0-2.5 (breast cancer); 0.1-2.8, 0-3.7, and 0.2-2.9 (lung cancer); and 0-1.1, 0-0.9, and 0-0.6 (lymphoma), respectively, for the three treatment groups. The numbers of individual cancers (breast, lung, and lymphoma) in some registries were low; RRs were not available. There were a few cases of lymphoma in some of the registries; ARTIS observed an RR of 2.8 (95% CI 1.1-6.8) with abatacept versus csDMARDs. The pooled RRs (95% CIs) for overall malignancy with abatacept were 1.1 (0.8-1.5) versus csDMARDs and 1.0 (0.8-1.3) versus b/tsDMARDs. CONCLUSIONS This international, post-marketing observational safety study did not find any statistically significant increase in the risk of overall malignancies in pooled data in patients treated with abatacept compared with csDMARDs or with other b/tsDMARDs. Assessment of larger populations is needed to further evaluate the risks for individual cancers, especially lymphoma.
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Affiliation(s)
| | | | - Maarten Boers
- Department of Epidemiology & Data Science, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marc C Hochberg
- Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Johan Askling
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE, USA; FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Anja Strangfeld
- Pharmacoepidemiology and Health Services Research, German Rheumatism Research Center, Berlin, Germany; Charité University Medicine, Berlin, Germany
| | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Thomas Frisell
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Yvette Meissner
- Pharmacoepidemiology and Health Services Research, German Rheumatism Research Center, Berlin, Germany
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13
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Bridge F, Brotherton J, Stankovich J, Sanfilippo PG, Skibina OG, Buzzard K, Kalincik T, Nguyen AL, Guo K, Monif M, Wrede CD, Rath L, Taylor L, Butzkueven H, Jokubaitis VG, Van Der Walt A. Risk of Cervical Abnormalities for Women With Multiple Sclerosis Treated With Moderate-Efficacy and High-Efficacy Disease-Modifying Therapies. Neurology 2024; 102:e208059. [PMID: 38306594 DOI: 10.1212/wnl.0000000000208059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/27/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The impact of immunomodulatory therapies on the risk of cervical pre-cancer and invasive cancer development is important for the health and safety of women with multiple sclerosis (wwMS). We investigate the risk of cervical abnormalities in wwMS treated with disease-modifying therapies (DMTs). METHODS This is a multicenter cohort study with data collected from 1998 to 2019 in Victoria, Australia. Data linkage was performed using matching records from the MSBase Registry, the National Human Papillomavirus (HPV) Vaccination Program Register, and the Victorian Cervical Cytology Register. The primary outcome was the detection of any type of cervical abnormality as determined by cytology or histology. Survival methods were used to assess the time to cervical abnormality detection on cervical screening tests (CSTs). Crude and adjusted Cox proportional hazards models were used to determine time to and magnitude of association of DMTs with the risk of cervical abnormality. In a sensitivity analysis, we constructed standardized survival curves averaged over the same set of covariates to determine the commensurate population-average (marginal) causal effects. RESULTS We included 248 wwMS. The incidence of abnormal CSTs was lower (p < 0.001) for women not exposed to moderate-high-efficacy therapy (10.2 per 1,000 patient-years [95% confidence interval (CI) 5.5-14.9]), compared with those exposed (36.6 per 1,000 patient-years [95% CI 21.7-51.6]). Exposure to higher efficacy treatment was associated with a 3.79-fold increased hazard (95% CI 2.02-7.08, p < 0.001) of developing a cervical abnormality relative to those not exposed. When adjusted for vaccination status, smoking, hormonal contraceptive use, and socioeconomic status, the risk remained elevated at 3.79 (95% CI 1.99-7.21, p < 0.001). Marginal hazard ratios declined over time, ranging from 3.90 (95% CI 2.09-7.27) at 20 years of age to 2.06 (95% CI 1.14-3.73) at 70 years of age. DISCUSSION A greater than three-and-a-half-fold increased risk of cervical abnormalities was found after exposure to moderate-high-efficacy DMTs. This risk persisted despite adjusting for HPV vaccination status, hormonal contraception use, smoking, and socioeconomic status. If confirmed in future studies, we would advocate for wwMS exposed to moderate-high-efficacy DMTs to be treated in line with immune-deficient paradigm in cervical screening and HPV vaccination programs. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that highly active MS therapy compared with less active therapy increases the risk of developing cervical abnormalities among women with MS.
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Affiliation(s)
- Francesca Bridge
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Julia Brotherton
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Jim Stankovich
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Paul G Sanfilippo
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Olga G Skibina
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Katherine Buzzard
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Tomas Kalincik
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Ai-Lan Nguyen
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Kylie Guo
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Mastura Monif
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - C David Wrede
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Louise Rath
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Lisa Taylor
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Helmut Butzkueven
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Vilija G Jokubaitis
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
| | - Anneke Van Der Walt
- From the Department of Neuroscience (F.B., J.S., P.G.S., O.G.S., M.M., H.B., V.G.J., A.V.D.W.), Central Clinical School, Monash University; Department of Neurology (F.B., O.G.S., M.M., L.R., H.B., V.G.J., A.V.D.W.), Alfred Health, Melbourne; Australian Centre for the Prevention of Cervical Cancer (formerly Victorian Cytology Service) (J.B.), Carlton South; Centre for Epidemiology and Biostatistics (J.B.), Melbourne School of Population and Global Health, University of Melbourne; Department of Neurosciences (O.G.S., K.B.), Eastern Health; MS Centre (K.B., T.K., A.-L.N., K.G., M.M., L.T.), Department of Neurology, Royal Melbourne Hospital; Eastern Health Clinical School (K.B., A.-L.N.), Monash University, Box Hill; CORe (T.K., A.-L.N.), Department of Medicine, University of Melbourne; Oncology and Dysplasia Unit (C.D.W.), Royal Women's Hospital, Parkville; and Department of Obstetrics and Gynaecology (C.D.W.), University of Melbourne, Australia
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14
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Simon TA, Dong L, Suissa S, Michaud K, Pedro S, Hochberg M, Boers M, Askling J, Frisell T, Strangfeld A, Meissner Y, Khaychuk V, Dominique A, Maldonado MA. Abatacept and non-melanoma skin cancer in patients with rheumatoid arthritis: a comprehensive evaluation of randomised controlled trials and observational studies. Ann Rheum Dis 2024; 83:177-183. [PMID: 37932010 PMCID: PMC10850629 DOI: 10.1136/ard-2023-224356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/29/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES This study aims to evaluate non-melanoma skin cancer (NMSC) risk associated with abatacept treatment for rheumatoid arthritis (RA). METHODS This evaluation included 16 abatacept RA clinical trials and 6 observational studies. NMSC incidence rates (IRs)/1000 patient-years (p-y) of exposure were compared between patients treated with abatacept versus placebo, conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) and other biological/targeted synthetic (b/ts)DMARDs. For observational studies, a random-effects model was used to pool rate ratios (RRs). RESULTS ~49 000 patients receiving abatacept were analysed from clinical trials (~7000) and observational studies (~42 000). In randomised trials (n=4138; median abatacept exposure, 12 (range 2-30) months), NMSC IRs (95% CIs) were not significantly different for abatacept (6.0 (3.3 to 10.0)) and placebo (4.0 (1.3 to 9.3)) and remained stable throughout the long-term, open-label period (median cumulative exposure, 28 (range 2-130 months); 21 335 p-y of exposure (7044 patients over 3 years)). For registry databases, NMSC IRs/1000 p-y were 5-12 (abatacept), 1.6-10 (csDMARDs) and 3-8 (other b/tsDMARDs). Claims database IRs were 19-22 (abatacept), 15-18 (csDMARDs) and 14-17 (other b/tsDMARDs). Pooled RRs (95% CIs) from observational studies for NMSC in patients receiving abatacept were 1.84 (1.00 to 3.37) vs csDMARDs and 1.11 (0.98 to 1.26) vs other b/tsDMARDs. CONCLUSIONS Consistent with the warnings and precautions of the abatacept label, this analysis suggests a potential increase in NMSC risk with abatacept use compared with csDMARDs. No significant increase was observed compared with b/tsDMARDs, but the lower limit of the 95% CI was close to unity.
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Affiliation(s)
- Teresa A Simon
- Global Pharmacovigilance and Epidemiology, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Lixian Dong
- Global Pharmacovigilance and Epidemiology, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Samy Suissa
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Kaleb Michaud
- Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Marc Hochberg
- Department of Medicine, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Maarten Boers
- Department of Epidemiology and Data Science, Amsterdam UMC - Vrije Universiteit, Amsterdam, The Netherlands
| | - Johan Askling
- Rheumatology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Anja Strangfeld
- Epidemiology and Health Services Research, German Rheumatism Research Center, Berlin, Germany
- Pharmakoepidemiologie, Charité University Medicine, Berlin, Germany
| | - Yvette Meissner
- Epidemiology and Health Services Research, German Rheumatism Research Center, Berlin, Germany
| | - Vadim Khaychuk
- US Medical Immunology and Fibrosis, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Alyssa Dominique
- Global Pharmacovigilance and Epidemiology, Bristol Myers Squibb, Princeton, New Jersey, USA
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15
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Westermann R, Cordtz RL, Duch K, Mellemkjaer L, Hetland ML, Burden AM, Dreyer L. Cancer risk in patients with rheumatoid arthritis treated with janus kinase inhibitors: a nationwide Danish register-based cohort study. Rheumatology (Oxford) 2024; 63:93-102. [PMID: 37052534 DOI: 10.1093/rheumatology/kead163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/01/2023] [Accepted: 03/24/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES We aimed to investigate the risk of first primary cancer in patients with RA treated with janus kinase inhibitors (JAKi) compared with those who received biologic DMARDs (bDMARDs) in a real-world setting. METHODS We performed an observational cohort study using the nationwide registers in Denmark. Patients with RA aged 18+ years, without a previous cancer diagnosis, and who initiated treatment with JAKi or bDMARDs from 1 January 2017 to 31 December 2020 were followed for any cancer (except non-melanoma skin cancer). We applied inverse probability of treatment weighting (IPTW) to account for covariate differences between treatment groups. IPTW-generated weights were used with cause-specific Cox (CSC) models to calculate hazard ratios (HRs) for cancer incidence in JAKi-treated compared with bDMARD-treated patients with RA. RESULTS We identified 875 and 4247 RA patients treated with JAKi and bDMARDs, respectively. The JAKi group contributed 1315 person years (PYRS) and 19 cancers, the bDMARD group contributed 8597 PYRS and 111 cancers, with corresponding crude incidence rates per 1000 PYRS of 14.4 and 12.9. Comparing the two groups using weighted CSC models, a HR of 1.41 (95% CI 0.76, 2.37, 95% CIs) was seen for JAKi- vs bDMARD-treated patients with RA. CONCLUSION JAKi treatment in real-world patients with RA was not associated with a statistically significant increased risk of first primary cancer compared with those who received bDMARDs. However, several numerically increased risk estimates were detected, and a clinically important excess risk of cancer among JAKi recipients cannot be dismissed.
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Affiliation(s)
- Rasmus Westermann
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg University, Denmark
- Clinical Cancer Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - René Lindholm Cordtz
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg University, Denmark
| | - Kirsten Duch
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg University, Denmark
- Unit of Clinical Biostatistics, Aalborg University Hospital, Denmark
| | - Lene Mellemkjaer
- Danish Cancer Society Research Center (DCRC), Copenhagen, Denmark
| | - Merete Lund Hetland
- The DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
| | - Andrea Michelle Burden
- Pharmacoepidemiology Group, Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Lene Dreyer
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg University, Denmark
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Balsa A, Díaz Del Campo Fontecha P, Silva Fernández L, Valencia Martín J, Nistal Martínez V, León Vázquez F, Hernández Hernández MV, Corominas H, Cáliz Cáliz R, Aguado García JM, Candelas Rodríguez G, Ibargoyen Roteta N, Martí Carvajal A, Plana Farras MN, Puñal Riobóo J, Park HS, Triñanes Pego Y, Villaverde García V. Recommendations by the Spanish Society of Rheumatology on risk management of biological treatment and JAK inhibitors in patients with rheumatoid arthritis. REUMATOLOGIA CLINICA 2023; 19:533-548. [PMID: 38008602 DOI: 10.1016/j.reumae.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/06/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To present recommendations based on the available evidence and the consensus of experts, for risk management of biological treatment and JAK inhibitors in patients with rheumatoid arthritis. METHODS Clinical research questions relevant to the purpose of the document were identified. These questions were reformulated in PICO format (patient, intervention, comparison, outcome or outcome) by a panel of experts, selected based on their experience in the area. A systematic review of the evidence was carried out, grading according to the GRADE criteria (Grading of Recommendations Assessment, Development, and Evaluation). Specific recommendations were then formulated. RESULTS 6 PICO questions were proposed by the panel of experts based on their clinical relevance and the existence of recent information regarding the risk of occurrence of serious infections, the risk of reactivation of the hepatitis B virus, the risk of reactivation of the virus varicella-zoster, the risk of appearance of skin (melanoma and non-melanoma) or haematological cancer, the risk of appearance of thromboembolic disease and the risk of progression of the human papilloma virus. A total of 28 recommendations were formulated, structured by question, based on the evidence found and the consensus of the experts. CONCLUSIONS The SER recommendations on risk management of treatment with biologic therapies and JAK inhibitors in rheumatoid arthritis are presented.
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Affiliation(s)
- Alejandro Balsa
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain
| | | | - Lucía Silva Fernández
- Servicio de Reumatología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - José Valencia Martín
- Unidad de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Fernando León Vázquez
- Medicina de Familia, Centro de Salud San Juan de la Cruz, Pozuelo de Alarcón, Madrid, Spain
| | - M Vanesa Hernández Hernández
- Servicio de Reumatología, Complejo Hospitalario Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - Héctor Corominas
- Servicio de Reumatología, Hospital Universitari de la Santa Creu i Sant Pau & Hospital Dos de Maig, Barcelona, Spain
| | | | - José María Aguado García
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre. CIBERINFEC, ISCIII. Departamento de Medicina, UCM, Madrid, Spain
| | | | - Nora Ibargoyen Roteta
- Servicio de Evaluación de Tecnologías Sanitarias del País Vasco (Osteba). BIOEF, Barakaldo, Vizcaya, Spain
| | - Arturo Martí Carvajal
- Cátedra Rectoral de Medicina basada en la Evidencia, Universidad de Carabobo, Venezuela; Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - M Nieves Plana Farras
- Unidad de Evaluación de Tecnologías Sanitarias, Hospital Ramón y Cajal, IRYCIS. CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Janet Puñal Riobóo
- Unidad de Asesoramiento Científico-técnico, Avalia-t, Agencia Gallega para la Gestión del Conocimiento en Salud, ACIS, Santiago de Compostela, A Coruña, Spain
| | - Hye Sang Park
- Servicio de Reumatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Yolanda Triñanes Pego
- Unidad de Asesoramiento Científico-técnico, Avalia-t, Agencia Gallega para la Gestión del Conocimiento en Salud, ACIS, Santiago de Compostela, A Coruña, Spain
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Mizushima M, Sugihara T, Matsui T, Urata Y, Tohma S, Kawahata K. Comparison between rheumatoid arthritis with malignant lymphoma and other malignancies: Analysis of a National Database of Rheumatic Disease in Japan. Semin Arthritis Rheum 2023; 63:152301. [PMID: 37939601 DOI: 10.1016/j.semarthrit.2023.152301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The background status and the current treatment options of patients with rheumatoid arthritis (RA) who develop malignant lymphoma (ML) and other malignancies are unclear. This study investigated the differences in background factors between ML and other malignancies that occur in RA patients and post-malignancy treatment. METHODS We identified 935 RA patients with new-onset malignancies among 110,571 person-years registered in the National Database of Rheumatic Disease in Japan from 2012 to 2018. Analysis cohorts 1 and 2 included 597 and 490 patients with available data for 1 year before and after the development of malignancies, respectively. Factors associated with the development of ML were longitudinally evaluated by multiple logistic regression analyses. RESULTS Of the 935 patients (mean age 70.5, standard deviation 9.9), 15.5% had ML; this was comparable to the rate of lung cancer (14.3%). In cohort 1, methotrexate (MTX), biological disease-modifying anti-rheumatic drugs (bDMARDs), and non-steroidal anti-inflammatory drugs (NSAIDs) were used in 74.4%, 23.4%, and 56.7% of ML and in 56.8%, 25.4%, and 35.3% of other malignancies 1 year before the occurrence of malignancies. Clinical disease activity index (CDAI) and C-reactive protein were similar between the two groups. Multivariable analysis showed that MTX use (odds ratio [OR]: 2.22, 95% CI [confidence interval]: 1.32-3.73, p=0.003) and NSAID use (OR: 2.51, 95% CI: 1.58-3.98, p <0.001) were significantly associated with the development of ML versus other malignancies. However, this association was not observed with bDMARDs. In cohort 2, one year after the development of malignancies, MTX was used in none of ML and 41.8% of patients who developed other malignancies. In both malignancy groups, approximately 15% of patients received bDMARDs and 50% received glucocorticoids. IL-6 inhibitors were preferentially prescribed in patients with ML versus those with other malignancies. At year 1, CDAI remission was achieved in 37.3% and 31.1% of patients in the ML and other malignancy groups, respectively. CONCLUSION Patients receiving long-term treatment with MTX and NSAIDs may be at a relatively high risk of developing ML. The treatment landscape after developing malignancies differed considerably between patients with ML and other malignancies, and different treatment strategies should be established.
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Affiliation(s)
- Machiko Mizushima
- Department of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takahiko Sugihara
- Department of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Toshihiro Matsui
- Department of Rheumatology Research, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Yukitomo Urata
- Department of Rheumatology, Tsugaru General Hospital, Goshogawara, Japan
| | - Shigeto Tohma
- Department of Rheumatology, National Hospital Organization Tokyo Hospital
| | - Kimito Kawahata
- Department of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Japan
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18
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Beydon M, Pinto S, De Rycke Y, Fautrel B, Mariette X, Seror R, Tubach F. Risk of cancer for patients with rheumatoid arthritis versus general population: a national claims database cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100768. [PMID: 37954220 PMCID: PMC10637983 DOI: 10.1016/j.lanepe.2023.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023]
Abstract
Background Older studies uncovered an increased risk of cancer in patients with rheumatoid arthritis between 10% and 30% compared to the general population, with a lack of data concerning infrequent cancers. In recent year, major therapeutic breakthroughs might have affected this risk of cancer by mitigating disease activity or on the contrary by impairing antitumoral immune response. The objectives of this study are to compare cancer risk in patients with treated rheumatoid arthritis to the general population, in all treated patients and according to treatment exposure. Methods This is a nationwide population-based study within the French national claims database "Système National des Données de Santé" (SNDS) between January 1st 2010 and December 31st 2020, to estimate the age and sex-standardized incidence ratios of cancer (all sites and site specific) of treated rheumatoid arthritis patients, with the French population as reference (by use of the French Network of Population-Based Cancer Registries [FRANCIM]). Findings During the study period, 257,074 treated patients with rheumatoid arthritis contributed to a total of 2,098,238 person-years for the main analysis. The all-cancer risk was increased in rheumatoid arthritis patients, with a SIR (Standardized Incidence Ratio) of 1.20 (95% CI [1.17-1.23]). This risk was increased particularly for lung (SIR 1.41, 95% CI [1.36-1.46], bladder (SIR 2.38 95% CI [2.25-2.51]), cervix (SIR 1.80, 95% CI [1.62-2.01]), prostate (SIR 1.08, 95% CI [1.04, 1.13]) cancers, melanoma (SIR 1.37, 95% CI [1.29-1.46]), diffuse large B cell lymphoma (SIR 1.79, 95% CI [1.63-1.96], multiple myeloma (SIR 1.42, 95% CI [1.27-1.60]) and Hodgkin's lymphoma (SIR 2.73, 95% CI [2.31-3.23]). Some cancers were less frequent than in the general population such as pancreatic (SIR 0.90, 95% CI [0.83-0.97]) as well as breast and endometrial cancers (SIR 0.91, 95% CI [0.88-0.94] and SIR 0.77, 95% CI [0.71-0.84] respectively). Although we observed a modest but significant relative increase of all-cancer risk over-time in rheumatoid arthritis patients, there was a trend towards a decrease in risk of non-Hodgkin's lymphoma. Patients treated with rituximab were the patients displaying the highest risk of cancer. Interpretation Compared to the general population, treated rheumatoid arthritis patients were at greater risk of all-cancer and some site specific cancers, except for breast, pancreatic and endometrial cancers which were less frequent than in the general population. Funding This work was supported by unrestricted grants from the InCA (national institute against cancer) and AP-HP (Assistance Publique des Hôpitaux de Paris).
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Affiliation(s)
- Maxime Beydon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
| | - Sandrine Pinto
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
| | - Yann De Rycke
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, F75013, Paris, France
| | - Bruno Fautrel
- Département de Rhumatologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Xavier Mariette
- Département de Rhumatologie, Université Paris-Saclay, INSERM U1184, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, Paris, France
| | - Raphaèle Seror
- Département de Rhumatologie, Université Paris-Saclay, INSERM U1184, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, Paris, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, F75013, Paris, France
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He J, Lin X, Wang X, Lin T, Lyu S, Gao X, Chen J, Wang Q. Arecoline hydrobromide suppresses PI3K/AKT pathway in rheumatoid arthritis synovial fibroblasts and relieves collagen-induced arthritis in mice. Int Immunopharmacol 2023; 124:110925. [PMID: 37742366 DOI: 10.1016/j.intimp.2023.110925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE This study investigated the effectiveness of arecoline hydrobromide (AH) on the functions of rheumatoid arthritis fibroblast-like synoviocytes (RA-FLSs) and collagen-induced arthritis (CIA) mice. METHODS Immunofluorescence was used to identify RA-FLSs. Cell Counting Kit-8 (CCK-8) was used to determine the viability of RA-FLSs and the half maximal inhibitory concentration (IC50) of AH. The 5-ethynyl-2'-deoxyuridine (EdU) assay was used to detect DNA replication in RA-FLSs. Cell cycle and apoptosis were examined by flow cytometry. Migration and invasion, as well as wound healing assays, were employed to determine cell migration and invasion ability. Proteins and mRNA expression levels were investigated using Western blot, quantitative real-time PCR (RT-qPCR), and immunofluorescence. The CIA mice model was used to assess the effect of AH in vivo. RNA-sequencing (RNA-seq) was used to find the potential signaling pathways of AH against RA, and Western blot was used to verify the key signaling pathway of AH on RA-FLSs. Network pharmacology and molecular docking were used to predict drug targets. RESULTS AH inhibited the proliferation and DNA replication of RA-FLSs, promoted cell cycle arrest by reducing the levels of cyclin-dependent kinase 1 (CDK1), cyclin A2, and cyclin B1, promoted apoptosis by suppressing B-cell lymphoma-2 (Bcl-2) expression, and suppressed migration and invasion by inhibiting vimentin expression in RA-FLSs. AH was also effective in relieving arthritis in vivo. RNA sequencing analyses suggested that AH inhibited the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway in RA-FLSs, which was also confirmed in Western blot analysis. Furthermore, network pharmacology and molecular docking suggested that F2, MAPK14, SRC, AKT1, and CTSK might be the direct targets of AH. CONCLUSION AH can modulate the pathological process of RA-FLSs by blocking the PI3K/AKT pathway and relieve CIA in mice, making it a potential new small molecule candidate.
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Affiliation(s)
- Jiaxin He
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen 518036, China; Institute of Immunology and Inflammatory Diseases, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China; Shenzhen Key Laboratory of Inflammatory and Immunology Diseases, Shenzhen 518036, China.
| | - Xian Lin
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen 518036, China; Institute of Immunology and Inflammatory Diseases, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China; Shenzhen Key Laboratory of Inflammatory and Immunology Diseases, Shenzhen 518036, China.
| | - Xiaocheng Wang
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen 518036, China; Institute of Immunology and Inflammatory Diseases, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China; Shenzhen Key Laboratory of Inflammatory and Immunology Diseases, Shenzhen 518036, China.
| | - Tengyu Lin
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen 518036, China; Institute of Immunology and Inflammatory Diseases, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China; Shenzhen Key Laboratory of Inflammatory and Immunology Diseases, Shenzhen 518036, China
| | - Shuyan Lyu
- Institute of Immunology and Inflammatory Diseases, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China.
| | - Xu Gao
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen 518036, China; Institute of Immunology and Inflammatory Diseases, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China; Shenzhen Key Laboratory of Inflammatory and Immunology Diseases, Shenzhen 518036, China.
| | - Jian Chen
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen 518036, China; Institute of Immunology and Inflammatory Diseases, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China; Shenzhen Key Laboratory of Inflammatory and Immunology Diseases, Shenzhen 518036, China.
| | - Qingwen Wang
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen 518036, China; Institute of Immunology and Inflammatory Diseases, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China; Shenzhen Key Laboratory of Inflammatory and Immunology Diseases, Shenzhen 518036, China.
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20
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Wang F, Palmer N, Fox K, Liao KP, Yu KH, Kou SC. Large-scale real-world data analyses of cancer risks among patients with rheumatoid arthritis. Int J Cancer 2023; 153:1139-1150. [PMID: 37246892 PMCID: PMC10524922 DOI: 10.1002/ijc.34606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/16/2023] [Accepted: 04/27/2023] [Indexed: 05/30/2023]
Abstract
Rheumatoid arthritis (RA) affects 24.5 million people worldwide and has been associated with increased cancer risks. However, the extent to which the observed risks are related to the pathophysiology of rheumatoid arthritis or its treatments is unknown. Leveraging nationwide health insurance claims data with 85.97 million enrollees across 8 years, we identified 92 864 patients without cancers at the time of rheumatoid arthritis diagnoses. We matched 68 415 of these patients with participants without rheumatoid arthritis by sex, race, age and inferred health and economic status and compared their risks of developing all cancer types. By 12 months after the diagnosis of rheumatoid arthritis, rheumatoid arthritis patients were 1.21 (95% confidence interval [CI] [1.14, 1.29]) times more likely to develop any cancer compared with matched enrollees without rheumatoid arthritis. In particular, the risk of developing lymphoma is 2.08 (95% CI [1.67, 2.58]) times higher in the rheumatoid arthritis group, and the risk of developing lung cancer is 1.69 (95% CI [1.32, 2.13]) times higher. We further identified the five most commonly used drugs in treating rheumatoid arthritis, and the log-rank test showed none of them is implicated with a significantly increased cancer risk compared with rheumatoid arthritis patients without that specific drug. Our study suggested that the pathophysiology of rheumatoid arthritis, rather than its treatments, is implicated in the development of subsequent cancers. Our method is extensible to investigating the connections among drugs, diseases and comorbidities at scale.
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Affiliation(s)
- Feicheng Wang
- Department of Statistics, Harvard University, Cambridge, MA
| | - Nathan Palmer
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
| | - Kathe Fox
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
| | | | - Kun-Hsing Yu
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
| | - S. C. Kou
- Department of Statistics, Harvard University, Cambridge, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
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21
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Yamaoka K, Oku K. JAK inhibitors in rheumatology. Immunol Med 2023; 46:143-152. [PMID: 36744577 DOI: 10.1080/25785826.2023.2172808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/22/2023] [Indexed: 02/07/2023] Open
Abstract
Janus kinase inhibitors (JAKis) are a group of drugs with a different mechanism of action from biologics and are most rapidly uptaken in the rheumatology field. JAK is a protein kinase activated in the cytoplasm by multiple cytokines and hormones involved in inflammatory pathology. The expression of JAK has been observed in various diseases, indicating the utility of JAK inhibitors in a wide variety of immune-mediated inflammatory diseases. Clinical trials are underway for a number of different rheumatic diseases based on the therapeutic efficacy of JAKis, which is comparable to that of biologics. This article will review the current status of JAKis for rheumatic diseases in terms of efficacy and safety and extend to future clinical applications for rare diseases.
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Affiliation(s)
- Kunihiro Yamaoka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kenji Oku
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
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22
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Kunishita Y, Ichikawa K, Uzawa Y, Mitsuhashi M, Yoshioka Y, Okubo T, Nagaoka S. Efficacy and safety of abatacept in patients with rheumatoid arthritis with previous malignancy. Ther Adv Musculoskelet Dis 2023; 15:1759720X231186874. [PMID: 37539016 PMCID: PMC10395174 DOI: 10.1177/1759720x231186874] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/22/2023] [Indexed: 08/05/2023] Open
Abstract
Background Abatacept (ABT) is known to lower infection risk than other biologics and is effective and safe in elderly patients with rheumatoid arthritis (RA). However, there were inconsistent reports on the impact of ABT on malignancies which are more common in the elderly and strongly related to prognosis. Objectives This study aimed to evaluate the efficacy and safety of ABT in patients with RA with previous malignancy in clinical practice. Design A multicenter, retrospective study. Methods Patients who received ABT for RA in two hospitals in Yokohama until May 2022 were included in this study. The patients were divided into two groups according to the presence or absence of a history of malignancy (no previous malignancy: NP group, previous malignancy: PM group). The collected parameters were compared between the groups using propensity score matching. Results In this study, 312 patients were included, of whom 73 had previous malignancies when starting ABT. The age at ABT initiation was significantly higher in the PM group, the rate of methotrexate use was significantly lower in the PM group, and the Steinbrocker stage was significantly higher in the PM group. After matching these 3 factors, 68 patients were selected from each group. No significant differences in the ABT continuation rate, and malignancy incidence were observed between the two groups after ABT initiation. In addition to these factors, when matched for smoking history, interstitial lung disease, disease duration, sex, and inflammatory status, which are known risk factors for malignancy in RA, 40 patients were selected from each group. No significant differences in the ABT continuation rate, and malignancy incidence were observed between the two groups after ABT initiation. Conclusion In our clinical practice, ABT was as effective and safe in patients with a history of malignancy as in those without.
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Affiliation(s)
- Yosuke Kunishita
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-Ku, Yokohama, Kanagawa 236-0037, Japan
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kento Ichikawa
- Department of Hematology and Clinical Immunology, Yokohama City University Hospital, Yokohama, Japan
| | - Yuji Uzawa
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Masaki Mitsuhashi
- Department of Rheumatology, Saiseikai Yokohama-Shi Nanbu Hospital, Yokohama, Japan
| | - Yuji Yoshioka
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tadanobu Okubo
- Department of Rheumatology, Saiseikai Yokohama-Shi Nanbu Hospital, Yokohama, Japan
| | - Shouhei Nagaoka
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
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23
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Hatayama Y, Sugiyama H, Murakami D, Oura H, Shima Y, Shirato M, Nishino T, Nakazawa T, Suehiro K, Arai M. Primary Hepatic Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders After Methotrexate Therapy. J Med Cases 2023; 14:282-288. [PMID: 37692367 PMCID: PMC10482596 DOI: 10.14740/jmc4135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Prior reports described cases of lymphoproliferative diseases occurring after methotrexate (MTX) administration, which are called methotrexate-associated lymphoproliferative disorders (MTX-LPDs). It has become clear that these lymphoproliferative diseases also occur following treatment with other immunosuppressive drugs, and they have been termed as other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPDs). In most of these cases, the duration of immunosuppressive drugs is very long, on the order of years. In the present study, we evaluated the development of lymphoproliferative disease despite the short duration of immunosuppressive treatment and determined the tumor doubling time. A 71-year-old woman was diagnosed with adult-onset Still's disease. The patient was administered prednisone 30 mg per day starting on February 25, 2022 and MTX 6 mg per week starting 2 weeks later. Because she was a hepatitis B virus (HBV) carrier, nucleic acid analog therapy was also started to prevent HBV activation. Eight weeks later, biweekly tocilizumab was started. After 5 months of MTX administration, a solitary liver tumor measuring 37 × 32 mm2 was detected. Three months later, repeat computed tomography revealed that the liver tumor had grown rapidly to 7 cm in diameter. We considered the possibility of OIIA-LPDs and stopped MTX therapy. Biopsy specimens of the liver tumor exhibited lymphocyte proliferation, which was consistent with OIIA-LPDs. The doubling time for tumor growth was 33 days. Despite withdrawing MTX for 6 weeks, the tumor continued to grow, and thus, the patient was referred to the hematology unit. In previously reported cases of MTX-LPDs of hepatic origin, the average duration of MTX administration was 7.3 (2 - 13) years. This report describes a primary hepatic OIIA-LPDs-associated tumor that rapidly increased in size after an extremely short period of MTX administration.
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Affiliation(s)
- Yasuki Hatayama
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Harutoshi Sugiyama
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Daisuke Murakami
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Hirotaka Oura
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Yukiko Shima
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Miho Shirato
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Takayoshi Nishino
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Tadao Nakazawa
- Department of Pathology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Kenichi Suehiro
- Center for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba 275-8580, Japan
| | - Makoto Arai
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
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24
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Axfors C, Patel CJ, Ioannidis JPA. Published registry-based pharmacoepidemiologic associations show limited concordance with agnostic medication-wide analyses. J Clin Epidemiol 2023; 160:33-45. [PMID: 37224981 DOI: 10.1016/j.jclinepi.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/13/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To assess how the results of published national registry-based pharmacoepidemiology studies (where select associations are of interest) compare with an agnostic medication-wide approach (where all possible drug associations are tested). STUDY DESIGN AND SETTING We systematically searched for publications that reported drug associations with any, breast, colon/colorectal, or prostate cancer in the Swedish Prescribed Drug Registry. Results were compared against a previously performed agnostic medication-wide study on the same registry. PROTOCOL https://osf.io/kqj8n. RESULTS Most published studies (25/32) investigated previously reported associations. 421/913 (46%) associations had statistically significant results. 134 of the 162 unique drug-cancer associations could be paired with 70 associations in the agnostic study (corresponding drug categories and cancer types). Published studies reported smaller effect sizes and absolute effect sizes than the agnostic study, and generally used more adjustments. Agnostic analyses were less likely to report statistically significant protective associations (based on a multiplicity-corrected threshold) than their paired associations in published studies (McNemar odds ratio 0.13, P = 0.0022). Among 162 published associations, 36 (22%) showed increased risk signal and 25 (15%) protective signal at P < 0.05, while for agnostic associations, 237 (11%) showed increased risk signal and 108 (5%) protective signal at a multiplicity-corrected threshold. Associations belonging to drug categories targeted by individual published studies vs. nontargeted had smaller average effect sizes; smaller P values; and more frequent risk signals. CONCLUSION Published pharmacoepidemiology studies using a national registry addressed mostly previously proposed associations, were mostly "negative", and showed only modest concordance with their respective agnostic analyses in the same registry.
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Affiliation(s)
- Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, Stanford University, Stanford, CA, USA
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25
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Sonomoto K, Tanaka Y. Malignancies and rheumatoid arthritis, csDMARDs, biological DMARDs, and JAK inhibitors: challenge and outlook. Expert Rev Clin Immunol 2023; 19:1325-1342. [PMID: 37578325 DOI: 10.1080/1744666x.2023.2247158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is an autoimmune disorder necessitating immunosuppressive therapy. Remarkable progress has been made in the treatment of RA over recent decades, particularly with the development of biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi). Nonetheless, the development of new drugs has been accompanied by concerns regarding the association between these novel therapies and the risk of malignancy. AREAS COVERED This narrative review aims to discuss the understanding of RA, conventional synthetic (cs) DMARDs, bDMARDs, JAKi, and their association with malignancy. Furthermore, the review discusses the management of malignancy in patients receiving b/tsDMARDs. EXPERT OPINION Although recent studies suggest that the potential risk of malignancy of methotrexate and a JAKi tofacitinib, it is essential to avoid indiscriminate withholding of treatment by those agents, as this may lead functional impairment and increased mortality. Therefore, the adoption of a Treat-to-Target (T2T) approach considering individual patient characteristics, becomes of utmost importance. Rheumatologists should maintain a vigilant stance regarding malignancy in this context, recognizing the importance of early detection and management. Implementing a screening program for malignancies is indispensable, and the use of computed tomography screening may enhance the effectiveness of management strategies.
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Affiliation(s)
- Koshiro Sonomoto
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health Japan, Fukuoka, Japan
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Japan, Fukuoka, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Japan, Fukuoka, Japan
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26
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Dominique A, Hetland ML, Finckh A, Gottenberg JE, Iannone F, Caporali R, Kou TD, Nordstrom D, Hernandez MV, Sánchez-Piedra C, Sánchez-Alonso F, Pavelka K, Bond TC, Simon TA. Safety outcomes in patients with rheumatoid arthritis treated with abatacept: results from a multinational surveillance study across seven European registries. Arthritis Res Ther 2023; 25:101. [PMID: 37308978 DOI: 10.1186/s13075-023-03067-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/11/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) have an increased risk of infection and malignancy compared with the general population. Infection risk is increased further with the use of disease-modifying antirheumatic drugs (DMARDs), whereas evidence on whether the use of biologic DMARDs increases cancer risk remains equivocal. This single-arm, post-marketing study estimated the incidence of prespecified infection and malignancy outcomes in patients with RA treated with intravenous or subcutaneous abatacept. METHODS Data were included from seven European RA quality registries: ATTRA (Anti-TNF Therapy in Rheumatoid Arthritis [Czech Republic]), DANBIO (Danish Rheumatologic Database), ROB-FIN (National Registry of Antirheumatic and Biological Treatment in Finland), ORA (Orencia and Rheumatoid Arthritis [France]), GISEA (Italian Group for the Study of Early Arthritis), BIOBADASER (Spanish Register of Adverse Events of Biological Therapies in Rheumatic Diseases), and the SCQM (Swiss Clinical Quality Management) system. Each registry is unique with respect to design, data collection, definition of the study cohort, reporting, and validation of outcomes. In general, registries defined the index date as the first day of abatacept treatment and reported data for infections requiring hospitalization and overall malignancies; data for other infection and malignancy outcomes were not available for every cohort. Abatacept exposure was measured in patient-years (p-y). Incidence rates (IRs) were calculated as the number of events per 1000 p-y of follow-up with 95% confidence intervals. RESULTS Over 5000 patients with RA treated with abatacept were included. Most patients (78-85%) were female, and the mean age range was 52-58 years. Baseline characteristics were largely consistent across registries. Among patients treated with abatacept, IRs for infections requiring hospitalization across the registries ranged from 4 to 100 events per 1000 p-y, while IRs for overall malignancy ranged from 3 to 19 per 1000 p-y. CONCLUSIONS Despite heterogeneity between registries in terms of design, data collection, and ascertainment of safety outcomes, as well as the possibility of under-reporting of adverse events in observational studies, the safety profile of abatacept reported here was largely consistent with previous findings in patients with RA treated with abatacept, with no new or increased risks of infection or malignancy.
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Affiliation(s)
| | - Merete Lund Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Axel Finckh
- Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
| | | | | | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- ASST PINI-CTO Hospital, Milan, Italy
| | | | - Dan Nordstrom
- Departments of Medicine and Rheumatology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
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27
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Pantano I, Mauro D, Simone D, Costa L, Capocotta D, Raimondo M, Birra D, Cuomo G, D'Errico T, Ferrucci M, Comentale F, Italiano G, Moscato P, Pappone N, Russo R, Scarpato S, Tirri R, Buono P, Postiglione A, Guida R, Scarpa R, Trama U, Tirri E, Ciccia F. The data project: a shared approach between stakeholders of the healthcare system in definition of a therapeutic algorithm for inflammatory arthritis. Reumatismo 2023; 74. [PMID: 36942981 DOI: 10.4081/reumatismo.2022.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/05/2022] [Indexed: 03/23/2023] Open
Abstract
Rheumatic musculoskeletal diseases or RMD [rheumatoid arthritis (RA) and spondyloarthritis (SpA)] are systemic inflammatory diseases for which there are no biomarkers capable of predicting treatments with a higher likelihood of response in naive patients. In addition, the expiration of the anti-TNF blocking drugs' patents has resulted in the availability of anti-TNF biosimilar drugs with the same efficacy and safety than originators but at significantly reduced prices. To guarantee a personalized therapeutic approach to RMD treatment, a board of rheumatologists and stakeholders from the Campania region, Italy, developed a clinically applicable arthritis therapeutic algorithm to guide rheumatologists (DATA project). The general methodology relied on a Delphi technique forecast to produce a set of statements that summarized the experts' consensus. Selected clinical scenarios were discussed in light of the available evidence, and there were two rounds of voting on the therapeutic approaches. Separate discussions were held regarding rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. The decision-making factors for each disease were clinical presentation, demographics, and comorbidities. In this paper, we describe a virtuous process between rheumatologists and healthcare system stakeholders that resulted in the development of a shared therapeutic algorithm for RMD patients naive to bDMARDs.
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Affiliation(s)
- I Pantano
- Rheumatology Unit, Department of Precision Medicine, University della Campania 'L. Vanvitelli', Naples.
| | - D Mauro
- Rheumatology Unit, Department of Precision Medicine, University della Campania 'L. Vanvitelli', Naples.
| | - D Simone
- Rheumatology Unit, Department of Precision Medicine, University della Campania 'L. Vanvitelli', Naples.
| | - L Costa
- Rheumatology Unit, University Federico II of Naples, Naples.
| | - D Capocotta
- Rheumatology Unit, San Giovanni Bosco Hospital, Local Health Company, ASL NA1, Naples.
| | - M Raimondo
- Internal Medicine, S. Giuseppe Moscato Hospital, Avellino.
| | - D Birra
- Rheumatology Service, San Giovanni di Dio e Ruggi Hospital, Salerno.
| | - G Cuomo
- Rheumatology Unit, Department of Precision Medicine, University della Campania 'L. Vanvitelli', Naples.
| | - T D'Errico
- Rheumatologist, Local Health Company, ASL NA1, Naples.
| | - M Ferrucci
- Rheumatology Unit, Rummo Hospital, Benevento.
| | - F Comentale
- Rheumatologist, Local Health Company, ASL NA3 Sud, Naples.
| | - G Italiano
- Internal Medicine, Sant'Anna e San Sebastiano Hospital, Caserta.
| | - P Moscato
- Rheumatology Service, San Giovanni di Dio e Ruggi Hospital, Salerno.
| | - N Pappone
- Rheumatological Rehabilitation Unit, Maugeri Foundation, Telese.
| | - R Russo
- Rheumatology Unit, Antonio Cardarelli Hospital of Naples, Naples.
| | - S Scarpato
- Rheumatology Unit, Scarlato Hospital, Scafati (SA).
| | - R Tirri
- Rheumatology Unit, Department of Precision Medicine, University della Campania 'L. Vanvitelli', Naples.
| | - P Buono
- STAFF 91 Unit, Regione Campania, Naples.
| | - A Postiglione
- General Direction for Health Protection and Coordination of the Regional Health System, Regione Campania, Naples.
| | - R Guida
- Drug Policy and Devices Unit, Regione Campania Health Department, Naples.
| | - R Scarpa
- Rheumatology Unit, University Federico II of Naples, Naples.
| | - U Trama
- Drug Policy and Devices Unit, Regione Campania Health Department, Naples.
| | - E Tirri
- Rheumatology Unit, San Giovanni Bosco Hospital, Local Health Company, ASL NA1, Naples.
| | - F Ciccia
- Rheumatology Unit, Department of Precision Medicine, University della Campania 'L. Vanvitelli', Naples.
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28
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Krüger K. [DMARD (disease-modifying antirheumatic drug) treatment in patients with former or current cancer]. Z Rheumatol 2023; 82:206-211. [PMID: 36757415 DOI: 10.1007/s00393-023-01316-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 02/10/2023]
Abstract
In contrast to the original fear that treatment with disease-modifying antirheumatic drugs (DMARDs) and especially with biologic DMARDs (bDMARDs), was associated with an increased risk of the induction of malignancies, this has meanwhile fortunately not been confirmed over the long-term administration. Evaluations from register-based investigations as well as from other long-term cohort studies confirm that neither conventional DMARDs, such as methotrexate, nor tumor necrosis factor (TNF) inhibitors or biologics with a different mode of action show such a risk for induction of cancer or hematological malignancies (for skin tumors see the other article). Regarding the question whether recurrences of former malignancies can be induced by DMARDs, the database is considerably smaller; however, published investigations dealing with this topic so far signal that also in this respect no increased risk can be found. When comparing the individual substances with each other no substantial differences can be found. Although used in the treatment of hematological cancers, rituximab does not offer any advantages in comparison to other biologics. For the group of Janus kinase (JAK) inhibitors, which have been in use only for a few years, data outside the randomized controlled studies (which are limited in time and are conducted with a selected patient population) are limited so that a clear statement regarding the malignancy risk is not yet possible for these substances. In a solitary study comparing tofacitinib with TNF inhibitors in high-risk patients, the malignancy risk of the JAK inhibitor was increased compared to that under TNF inhibitor treatment; however, these results have not yet been confirmed by a second investigation.
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Affiliation(s)
- Klaus Krüger
- Rheumatologisches Praxiszentrum, St. Bonifatius Str. 5, 81541, München, Deutschland.
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Wetzman A, Lukas C, Gaujoux-Viala C, Mamtani R, Barnetche T, Combe B, Morel J, Szafors P. Risk of Cancer After Initiation of Targeted Therapies in Patients With Rheumatoid Arthritis and a Prior Cancer: Systematic Review With Meta-Analysis. Arthritis Care Res (Hoboken) 2023; 75:260-271. [PMID: 34549898 DOI: 10.1002/acr.24784] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/29/2021] [Accepted: 09/14/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the risk of recurrent or new malignancy with exposure to targeted disease-modifying antirheumatic drugs (DMARDs) in adults with rheumatoid arthritis (RA), axial spondyloarthritis (SpA), or psoriatic arthritis (PsA) and a history of cancer. METHODS We performed a systematic search of the literature for articles published up to June 2019 that investigated adults with RA, axial SpA, or PsA who had a history of cancer and received biologic or targeted synthetic DMARDs (bDMARDs or tsDMARDs). We compared the risk of relapse or occurrence of new cancer between patients with and without bDMARDs. Rate ratios (RRs) with 95% confidence intervals (95% CIs) were estimated. The heterogeneity of the studies was evaluated by the Cochran Q test and the I2 statistic. RESULTS We included 24 observational studies of chronic inflammatory arthritis; of those, 12 were included in the meta-analysis of RA patients receiving bDMARDs. As compared with RA patients with a history of cancer and not receiving bDMARDs, for those receiving any bDMARD, the overall RR for risk of neoplasia was 1.09 (95% CI 0.92-1.32; P = 0.31, I2 = 8%); with tumor necrosis factor inhibitors, it was 1.11 (95% CI 0.85-1.46; P = 0.45, I2 = 48%); and with rituximab, it was 0.79 (95% CI 0.41-1.53; P = 0.49, I2 = 0%). The RR for risk of recurrence for skin cancer was 1.32 (95% CI 1.02-1.72; P = 0.04, I2 = 0%) and for breast neoplasia 1.21 (95% CI 0.84-1.72; P = 0.31, I2 = 0%). CONCLUSION Apart from skin cancers including melanoma, the risk of recurrent or new cancer is not increased with the initiation of bDMARDs for RA as compared with no bDMARDs.
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Affiliation(s)
| | | | - Cécile Gaujoux-Viala
- University of Montpellier, Montpellier, and Nîmes University Hospital, Nîmes, France
| | | | - Thomas Barnetche
- Fédération Hospitalo-Universitaire and Centre Hospitalier Universitaire, Pellegrin, Bordeaux, France
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Williams KC, Gault A, Anderson AE, Stewart CJ, Lamb CA, Speight RA, Rajan N, Plummer R, Pratt AG. Immune-related adverse events in checkpoint blockade: Observations from human tissue and therapeutic considerations. Front Immunol 2023; 14:1122430. [PMID: 36776862 PMCID: PMC9909476 DOI: 10.3389/fimmu.2023.1122430] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
Checkpoint inhibitors (CPIs) are monoclonal antibodies which, by disrupting interactions of immune checkpoint molecules with their ligands, block regulatory immune signals otherwise exploited by cancers. Despite revolutionary clinical benefits, CPI use is associated with an array of immune-related adverse events (irAEs) that mirror spontaneous autoreactivity. Severe irAEs necessitate pausing or stopping of CPI therapy and use of corticosteroids and/or other immunomodulatory interventions. Despite increasingly widespread CPI use, irAE pathobiology remains poorly understood; its elucidation may point to targeted mitigation strategies and uncover predictive biomarkers for irAE onset in patients, whilst casting new light on mechanisms of spontaneous immune-mediated disease. This review focuses on common CPI-induced irAEs of the gut, skin and synovial joints, and how these compare to immune-mediated diseases such as ulcerative colitis, vitiligo and inflammatory arthritis. We review current understanding of the immunological changes reported following CPI therapy at the level of peripheral blood and tissue. Many studies highlight dysregulation of cytokines in irAE-affected tissue, particularly IFNγ and TNF. IrAE-affected tissues are also predominantly infiltrated by T-cells, with low B-cell infiltration. Whilst there is variability between studies, patients treated with anti-programmed cell death-1 (PD-1)/PDL-1 therapies seem to exhibit CD8+ T-cell dominance, with CD4+ T-cells dominating in those treated with anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) monotherapy. Interestingly, CD8+CXCR3+ T-cells have been reported to be elevated in gastrointestinal, dermatological and musculoskeletal -irAE affected tissues. These findings may highlight potential opportunities for therapeutic development or re-deployment of existing therapies to prevent and/or improve the outcome of irAEs.
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Affiliation(s)
- Kristian C. Williams
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Abigail Gault
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Amy E. Anderson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Christopher J. Stewart
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Christopher A. Lamb
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - R. Ally Speight
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Neil Rajan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ruth Plummer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Arthur G. Pratt
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Directorate of Musculoskeletal Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Geng Z, Ye C, Zhu X. Malignancies in systemic rheumatic diseases: A mini review. Front Immunol 2023; 14:1095526. [PMID: 36926334 PMCID: PMC10011115 DOI: 10.3389/fimmu.2023.1095526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Abstract
There is an increased risk of malignancies in patients with many systemic rheumatic diseases, which negatively impact on their quality of life. The risk and types of malignancies can differ by the type of rheumatic diseases. Possible mechanisms linking them are dynamic and complicated, including chronic inflammation and damage in rheumatic disease, inability to clear oncogenic infections, shared etiology and some anti-rheumatic therapies. Although certain disease-modifying anti-rheumatic drugs (DMARDs) have been proved to be potentially carcinogenic, the majority of them were not associated with increased risk of most malignancies in patients with systemic rheumatic diseases.
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Affiliation(s)
- Zhe Geng
- Department of Hematology, Central Hospital of Wuhan, Wuhan, China
| | - Cong Ye
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojian Zhu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tidblad L, Westerlind H, Delcoigne B, Askling J, Saevarsdottir S. Comorbidities and treatment patterns in early rheumatoid arthritis: a nationwide Swedish study. RMD Open 2022; 8:rmdopen-2022-002700. [PMID: 36564100 PMCID: PMC9791425 DOI: 10.1136/rmdopen-2022-002700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine how comorbidities in patients with early rheumatoid arthritis (RA) associate with use of different disease-modifying antirheumatic drugs (DMARDs). METHODS We used Swedish nationwide clinical and quality registers to collect comorbidity data for patients diagnosed with RA during 2006-2019 (n=13 505). We compared the use of DMARDs at diagnosis and after 1 year, in relation to comorbidity categories 5 years prior to RA diagnosis and overall comorbidity burden. For each comorbidity category, we also calculated adjusted ORs of being on treatment with other (or no) DMARDs compared with methotrexate (MTX) monotherapy 1 year after RA diagnosis. RESULTS At RA diagnosis, 68% (n=9178) of all patients were treated with MTX monotherapy, with the lowest proportion in patients with chronic kidney (CKD, 48%, n=50) and respiratory diseases (57%, n=413). At 1 year, most patients still received MTX monotherapy (<11% decrease, across all comorbidity categories). At 1 year, 13% received biological/targeted synthetic DMARDs, with the lowest proportion among patients with malignant diseases (OR=0.69, 95% CI=0.51 to 0.95). Being without DMARD at 1 year was more common among patients with CKD (OR=3.25, 95% CI=2.20 to 4.81), respiratory diseases (OR=1.83, 95% CI=1.32 to 2.53) or a history of hospitalisation due to infection (OR=1.47, 95% CI=1.23 to 1.75), and among patients with higher comorbidity burden and older age. CONCLUSION In a nationwide setting with universal healthcare, most comorbid conditions do not limit the initiation or continuation of MTX or other DMARDs in early RA, although patients with certain comorbid conditions, higher comorbidity burden and higher age were somewhat less intensively treated.
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Affiliation(s)
- Liselotte Tidblad
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helga Westerlind
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Benedicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Saedis Saevarsdottir
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Ishitoku M, Yoshida Y, Matsubara T, Fujii K, Yorishima A, Oka N, Masuda S, Sugimoto T, Mokuda S, Masaki T, Hirata S. Cryoglobulinemic Vasculitis Associated with Monoclonal Gammopathy of Undetermined Significance Developed after Sustained Virologic Response of Hepatitis C: A Case Report. Intern Med 2022. [PMID: 36384905 PMCID: PMC10372272 DOI: 10.2169/internalmedicine.9768-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 72-year-old woman had a history of chronic hepatitis C virus (HCV) infection previously treated with interferon to achieve a sustained virologic response. Thereafter, she developed polyarthritis and purpura of the lower extremities as well as progressive renal dysfunction with hypertension and proteinuria that had occurred in the last three months. Laboratory investigations revealed seropositivity for cryoglobulin but negative findings for HCV RNA. She was ultimately diagnosed with cryoglobulinemic glomerulonephritis complicated by monoclonal gammopathy of undetermined significance (MGUS) based on the pathological findings of the kidney and bone marrow, indicating that MGUS-induced cryoglobulinemic vasculitis may occur even after HCV elimination.
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Affiliation(s)
- Michinori Ishitoku
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
| | - Yusuke Yoshida
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
| | - Toshiki Matsubara
- Postgraduate Clinical Training Center, Hiroshima University Hospital, Japan
| | - Kenji Fujii
- Department of Nephrology, Hiroshima University Hospital, Japan
| | - Ai Yorishima
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
| | - Naoya Oka
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
| | - Sho Masuda
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
| | - Tomohiro Sugimoto
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
| | - Sho Mokuda
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
- Department of Rheumatology, Medical Corporation JR Hiroshima Hospital, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
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Nasonov EL, Feist E. The prospects of interleukin-6 inhibition in rheumatoid arthritis: Olokizumab (novel monoclonal antibodies to IL-6). RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-505-518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic immune-mediated rheumatic diseases (IMRDs) manifested with progressive destruction of joints, systemic inflammation of visceral organs and a wide range of co-morbidities associated with chronic inflammation. Among the cytokines involved in the pathogenesis of RA and certain other IMRDs, the role of interleukin (IL) 6 is of special interest. The introduction of mAbs tocilizumab (TCZ) and later sarilumab (SAR), both blocking the receptor of this cytokine, into clinical practice was an important achievement in the treatment of IIRDs at the beginning of the 21st century. As a novel approach in the treatment of RA, the humanized mAb against IL-6 olokizumab (OKZ) is in development by the Russian company R-PHARM under the license agreement with UCB Pharma. The review examines new data on efficacy and safety of OKZ in RA and the prospects of its use in rheumatology
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Affiliation(s)
- E. L. Nasonov
- V.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)
| | - Eugen Feist
- Department of Rheumatology, Helios Clinic VogelsangGommern, cooperation partner of the Otto-vonGuericke University Magdeburg
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35
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Selva-O’Callaghan A, Trallero-Araguás E, Ros J, Gil-Vila A, Lostes J, Agustí A, Riera-Arnau J, Alvarado-Cárdenas M, Pinal-Fernandez I. Management of Cancer-Associated Myositis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2022; 8:91-104. [PMID: 36313478 PMCID: PMC9589595 DOI: 10.1007/s40674-022-00197-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 12/01/2022]
Abstract
Purpose of the Review Cancer-associated myositis (CAM) is defined as when cancer appears within 3 years of myositis onset. Dermatomyositis and seronegative immune–mediated necrotizing myopathy are the phenotypes mostly related to cancer. In general, treatment principles in myositis patients with and without CAM are similar. However, some aspects of myositis management are particular to CAM, including (a) the need for a multidisciplinary approach and a close relationship with the oncologist, (b) the presence of immunosuppressive and antineoplastic drug interactions, and (c) the role of the long-term immunosuppressive therapy as a risk factor for cancer relapse or development of a second neoplasm. In this review, we will also discuss immunotherapy in patients treated with checkpoint inhibitors as a treatment for their cancer. Recent Findings Studies on cancer risk in patients treated with long-term immunosuppressive drugs, in autoimmune diseases such as systemic lupus erythematosus or rheumatoid arthritis, and in solid organ transplant recipients have shed some light on this topic. Immunotherapy, which has been a great advance for the treatment of some types of malignancy, may be also of interest in CAM, given the special relationship between both disorders. Summary Management of CAM is a challenge. In this complex scenario, therapeutic decisions must consider both diseases simultaneously. Supplementary Information The online version contains supplementary material available at 10.1007/s40674-022-00197-2.
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Affiliation(s)
- Albert Selva-O’Callaghan
- Systemic Autoimmune Diseases Unit, Internal Medicine Dept, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Javier Ros
- Medical Oncology Department, Vall d’Hebron General Hospital, Barcelona, Spain
| | - Albert Gil-Vila
- Systemic Autoimmune Diseases Unit, Internal Medicine Dept, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julia Lostes
- Medical Oncology Department, Vall d’Hebron General Hospital, Barcelona, Spain
| | - Antonia Agustí
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Judit Riera-Arnau
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Barcelona, Spain
| | | | - Iago Pinal-Fernandez
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD USA
- Johns Hopkins University School of Medicine, Baltimore, MD USA
- Faculty of Health Sciences and Faculty of Computer Science, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
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36
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Jeon CH. Rheumatoid Arthritis and Malignancy: What Should We Do With DMARDs? JOURNAL OF RHEUMATIC DISEASES 2022; 29:191-192. [PMID: 37476429 PMCID: PMC10351408 DOI: 10.4078/jrd.22.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 07/22/2023]
Affiliation(s)
- Chan Hong Jeon
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Lepri G, Catalano M, Bellando-Randone S, Pillozzi S, Giommoni E, Giorgione R, Botteri C, Matucci-Cerinic M, Antonuzzo L, Guiducci S. Systemic Sclerosis Association with Malignancy. Clin Rev Allergy Immunol 2022; 63:398-416. [PMID: 36121543 DOI: 10.1007/s12016-022-08930-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 12/17/2022]
Abstract
The association of systemic sclerosis (SSc) and cancer is well known from several decades suggesting common genetic and environmental risk factors involved in the development of both diseases. Immunosuppressive drugs widely used in SSc may increase the risk of cancer occurrence and different SSc clinical and serological features identify patients at major risk to develop malignancy. In this context, among serological features, presence of anti-RNA polymerase III and anti-topoisomerase I autoantibodies seems to increase cancer frequency in SSc patients (particularly lung and breast cancers). Lung fibrosis and a long standing SSc pulmonary involvement have been largely proposed as lung cancer risk factors, and the exposure to cyclophosphamide and an upper gastrointestinal involvement have been traditionally linked to bladder and oesophagus cancers, respectively. Furthermore, immune checkpoint inhibitors used for cancer therapy can induce immune-related adverse events, which are more frequent and severe in patients with pre-existing autoimmune diseases such as SSc. The strong association between SSc and cancer occurrence steers clinicians to carefully survey SSc patients performing periodical malignancy screening. In the present review, the most relevant bilateral relationships between SSc and cancer will be addressed.
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Affiliation(s)
- Gemma Lepri
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology, AOUC & Scleroderma Unit, Florence, Italy.
| | - Martina Catalano
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology, AOUC & Scleroderma Unit, Florence, Italy
| | - Serena Pillozzi
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Elisa Giommoni
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | | | - Cristina Botteri
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology, AOUC & Scleroderma Unit, Florence, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology, AOUC & Scleroderma Unit, Florence, Italy
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Yamana S, Hasegawa E, Takeda A, Yawata N, Sonoda KH. Long-term outcomes of infliximab in patients with Behçet's disease-associated uveitis. Int Ophthalmol 2022; 43:937-944. [PMID: 36057758 DOI: 10.1007/s10792-022-02495-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate long-term outcomes of infliximab (IFX) treatment in patients with Behçet's disease (BD)-associated uveitis. PATIENTS AND METHODS We retrospectively analyzed the cases of patients with BD-associated uveitis treated with IFX for > 5 years. We compared the numbers of ocular inflammatory attacks, ocular disease activities, and visual acuity before and after the initiation of IFX treatment. RESULTS The 24 patients were 20 men and 4 women. Their mean age at the initiation of IFX treatment was 37.3 ± 9.2 years. The mean term from the initiation of IFX treatment was 10.3 ± 2.4 years. The average number of ocular inflammatory attacks was 5.4 ± 2.1 per 12 months before the IFX treatment and significantly lower at 0.83 ± 0.96 per 12 months after the initiation of IFX treatment (p < 0.05). We used a scoring system for BD-associated uveitis named the Behçet's disease ocular attack score 24 (BOS24) to estimate the changes in ocular disease activities between before and after initiation of IFX treatment. The average score decreased significantly from 7.58 ± 2.77 to 2.55 ± 2.74 after the initiation of IFX treatment (p < 0.05). Even after > 5 years of the treatment, both the number of ocular attacks and the BOS24 score kept decreasing. The visual acuity in 42 of 48 eyes (24 patients) was improved or maintained. CONCLUSIONS IFX was effective for controlling ocular inflammatory attacks and diminishing ocular disease activities in patients with BD-associated uveitis, and it maintained the patients' visual acuity.
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Affiliation(s)
- Satoshi Yamana
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Eiichi Hasegawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Atsunobu Takeda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Nobuyo Yawata
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Kastrati K, Aletaha D, Burmester GR, Chwala E, Dejaco C, Dougados M, McInnes IB, Ravelli A, Sattar N, Stamm TA, Takeuchi T, Trauner M, van der Heijde D, Voshaar MJH, Winthrop K, Smolen JS, Kerschbaumer A. A systematic literature review informing the consensus statement on efficacy and safety of pharmacological treatment with interleukin-6 pathway inhibition with biological DMARDs in immune-mediated inflammatory diseases. RMD Open 2022; 8:rmdopen-2022-002359. [PMID: 36260501 PMCID: PMC9462104 DOI: 10.1136/rmdopen-2022-002359] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/30/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives Informing an international task force updating the consensus statement on efficacy and safety of biological disease-modifying antirheumatic drugs (bDMARDs) selectively targeting interleukin-6 (IL-6) pathway in the context of immune-mediated inflammatory diseases. Methods A systematic literature research of all publications on IL-6 axis inhibition with bDMARDs published between January 2012 and December 2020 was performed using MEDLINE, EMBASE and Cochrane CENTRAL databases. Efficacy and safety outcomes were assessed in clinical trials including their long-term extensions and observational studies. Meeting abstracts from ACR, EULAR conferences and results on clinicaltrials.gov were taken into consideration. Results 187 articles fulfilled the inclusion criteria. Evidence for positive effect of IL-6 inhibition was available in various inflammatory diseases such as rheumatoid arthritis, juvenile idiopathic arthritis, giant cell arteritis, Takayasu arteritis, adult-onset Still’s disease, cytokine release syndrome due to chimeric antigen receptor T cell therapy and systemic sclerosis-associated interstitial lung disease. Newcomers like satralizumab and anti-IL-6 ligand antibody siltuximab have expanded therapeutic approaches for Castleman’s disease and neuromyelitis optica, respectively. IL-6 inhibition did not provide therapeutic benefits in psoriatic arthritis, ankylosing spondylitis and certain connective tissue diseases. In COVID-19, tocilizumab (TCZ) has proven to be therapeutic in advanced disease. Safety outcomes did not differ from other bDMARDs, except higher risks of diverticulitis and lower gastrointestinal perforations. Inconsistent results were observed in several studies investigating the risk for infections when comparing TCZ to TNF-inhibitors. Conclusion IL-6 inhibition is effective for treatment of several inflammatory diseases with a safety profile that is widely comparable to other bDMARDs.
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Affiliation(s)
- Kastriot Kastrati
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| | - Gerd R Burmester
- Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Eva Chwala
- University Library, Medical University of Vienna, Wien, Austria
| | - Christian Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria
- Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | - Iain B McInnes
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Angelo Ravelli
- UO Pediatria II-Reumatologia, Istituto Giannina Gaslini, Genova, Italy
| | - Naveed Sattar
- Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, UK
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Japan
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Medical University of Vienna Department of Medicine III, Wien, Austria
| | | | - Marieke J H Voshaar
- Department of Pharmacy and Department of Research & Innovation, Sint Maartenskliniek, Ubbergen, The Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kevin Winthrop
- Schools of Medicine and Public Health, Oregon Health and Science University, Portland, Oregon, USA
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
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Bruera S, Suarez-Almazor ME. The effects of glucocorticoids and immunosuppressants on cancer outcomes in checkpoint inhibitor therapy. Front Oncol 2022; 12:928390. [PMID: 36081549 PMCID: PMC9445222 DOI: 10.3389/fonc.2022.928390] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
The emergence of checkpoint inhibitors has created a paradigm shift for the treatment of various malignancies. However, although these therapies are associated with improved survival rates, they also carry the risk of immune-related adverse events (irAEs). Moderate to severe irAEs are typically treated with glucocorticoids, sometimes with the addition of immunosuppressants as steroid-sparing therapy. However, it is unclear how glucocorticoids and immunosuppressants may impact cancer survival and the efficacy of immune checkpoint therapy on cancer. In this narrative review, we discuss the effects of glucocorticoids and immunosuppressants including methotrexate, hydroxychloroquine, azathioprine, mycophenolate mofetil, tumor-necrosis factor (TNF)-inhibitors, interleukin-6 inhibitors, interleukin-1 inhibitors, abatacept, rituximab, and Janus kinase inhibitors (JAKi) on cancer-specific outcomes in the setting of immune checkpoint inhibitor use.
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Affiliation(s)
- Sebastian Bruera
- Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, TX, United States
| | - Maria E. Suarez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Maria E. Suarez-Almazor,
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Aletaha D, Kerschbaumer A, Kastrati K, Dejaco C, Dougados M, McInnes IB, Sattar N, Stamm TA, Takeuchi T, Trauner M, van der Heijde D, Voshaar M, Winthrop KL, Ravelli A, Betteridge N, Burmester GRR, Bijlsma JW, Bykerk V, Caporali R, Choy EH, Codreanu C, Combe B, Crow MK, de Wit M, Emery P, Fleischmann RM, Gabay C, Hetland ML, Hyrich KL, Iagnocco A, Isaacs JD, Kremer JM, Mariette X, Merkel PA, Mysler EF, Nash P, Nurmohamed MT, Pavelka K, Poor G, Rubbert-Roth A, Schulze-Koops H, Strangfeld A, Tanaka Y, Smolen JS. Consensus statement on blocking interleukin-6 receptor and interleukin-6 in inflammatory conditions: an update. Ann Rheum Dis 2022; 82:773-787. [PMID: 35953263 DOI: 10.1136/ard-2022-222784] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Targeting interleukin (IL)-6 has become a major therapeutic strategy in the treatment of immune-mediated inflammatory disease. Interference with the IL-6 pathway can be directed at the specific receptor using anti-IL-6Rα antibodies or by directly inhibiting the IL-6 cytokine. This paper is an update of a previous consensus document, based on most recent evidence and expert opinion, that aims to inform on the medical use of interfering with the IL-6 pathway. METHODS A systematic literature research was performed that focused on IL-6-pathway inhibitors in inflammatory diseases. Evidence was put in context by a large group of international experts and patients in a subsequent consensus process. All were involved in formulating the consensus statements, and in the preparation of this document. RESULTS The consensus process covered relevant aspects of dosing and populations for different indications of IL-6 pathway inhibitors that are approved across the world, including rheumatoid arthritis, polyarticular-course and systemic juvenile idiopathic arthritis, giant cell arteritis, Takayasu arteritis, adult-onset Still's disease, Castleman's disease, chimeric antigen receptor-T-cell-induced cytokine release syndrome, neuromyelitis optica spectrum disorder and severe COVID-19. Also addressed were other clinical aspects of the use of IL-6 pathway inhibitors, including pretreatment screening, safety, contraindications and monitoring. CONCLUSIONS The document provides a comprehensive consensus on the use of IL-6 inhibition to treat inflammatory disorders to inform healthcare professionals (including researchers), patients, administrators and payers.
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Affiliation(s)
- Daniel Aletaha
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | | | - Kastriot Kastrati
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Christian Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria.,Rheumatology, Brunico Hospital, Brunico, Italy
| | - Maxime Dougados
- Rheumatology, Universite Paris Descartes Faculte de Medecine Site Cochin, Paris, France
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Japan
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria
| | - Désirée van der Heijde
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Marieke Voshaar
- Department of Psychology, Health and Technology, Enschede, Netherlands and Stichting Tools Patient Empowerment, University of Twente, Enschede, The Netherlands
| | - Kevin L Winthrop
- Schools of Medicine and Public Health, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Angelo Ravelli
- UO Pediatria II-Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | | | - Johannes Wj Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vivian Bykerk
- Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, ASS G. Pini, University of Milan, Milano, Italy
| | - Ernest H Choy
- CREATE Centre, Section of Rheumatology, School of Medicine, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Catalin Codreanu
- Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Bernard Combe
- Immunorhumatologie, CHU Lapeyronie, Montpellier, France
| | - Mary K Crow
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, New York City, New York, USA
| | - Maarten de Wit
- Medical Humanities, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Paul Emery
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Roy M Fleischmann
- Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cem Gabay
- Division of Rheumatology, Geneva University Hospitals, Geneve, Switzerland
| | - Merete Lund Hetland
- Department of Clinical Medicine, Copenhagen University Hospital, Kobenhavn, Denmark.,Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Joel M Kremer
- Medicine Rheumatology, Albany Medical College, Albany, New York, USA
| | - Xavier Mariette
- Rheumatology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Center for Immunology of Viral Infections and Auto-immune Diseases, Université Paris-Sud, Gif-sur-Yvette, France
| | - Peter A Merkel
- Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eduardo F Mysler
- Organización Médica de Investigación SA, Buenos Aires, Argentina
| | - Peter Nash
- Griffith University School of Medicine, Gold Coast, Queensland, Australia
| | | | - Karel Pavelka
- Rheumatology Department, Charles University, Praha, Czech Republic
| | - Gyula Poor
- National Institute of Rheumatology & Physiology, Semmelweis University, Budapest, Hungary
| | - Andrea Rubbert-Roth
- Division of Rheumatology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Internal Medicine IV, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Anja Strangfeld
- Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Josef S Smolen
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
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Ohno M, Kuramitsu S, Iwakoshi A, Yamaguchi J, Ohka F, Saito R. Primary central nervous system malignant lymphoma in a patient with rheumatoid arthritis receiving tocilizumab: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22256. [PMID: 36088563 PMCID: PMC9706331 DOI: 10.3171/case22256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although the risk of developing malignant lymphoma is higher in patients with rheumatoid arthritis (RA) than in the general population, primary central nervous system lymphoma (PCNSL) in patients with RA is extremely rare. In recent years, there has been concern that biological disease-modifying antirheumatic drugs (bDMARDs), widely administered to patients with RA, might increase the risk of cancer development. The authors report the first case of PCNSL in a patient with RA receiving the bDMARD tocilizumab. OBSERVATIONS A 70-year-old man who was diagnosed with RA in 2010 was treated with low-dose methotrexate (MTX) from 2010 to 2015. Tocilizumab was commenced in 2012. In 2018, he developed gait disturbances, and gadolinium-enhanced magnetic resonance imaging showed multiple contrast-enhanced lesions in the basal ganglia and brain stem. Stereotactic brain biopsy led to the diagnosis of diffuse large B-cell lymphoma, and finally PCNSL was diagnosed. He was treated with five courses of MTX 3.5 g/m2, and his disease has been in remission for 34 months. LESSONS Low-dose MTX and bDMARDs are associated with the concern of increased cancer risk in patients with RA. Because tocilizumab has been in use for a relatively short time, further accumulation of cases and careful follow-up are necessary.
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Affiliation(s)
- Masasuke Ohno
- Department of Neurosurgery, Aichi Cancer Center, Nagoya, Japan
| | | | | | - Junya Yamaguchi
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Fumiharu Ohka
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
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Schmalzing M. [Management of inflammatory rheumatic diseases during and after malignancies]. Z Rheumatol 2022; 81:766-777. [PMID: 35796758 DOI: 10.1007/s00393-022-01237-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
The management of inflammatory rheumatic diseases in patients with a simultaneous or previous malignant disease is associated with complex questions. Difficulties and possible solutions in the interpretation of meaningful studies are presented. Recommendations in guidelines on this topic are discussed. National registries and health insurance databases were examined with respect to the risk of tumor recurrence under disease-modifying antirheumatic drugs; however, these analyses mainly refer to tumor necrosis factor (TNF) inhibitors and rituximab. Data on tumor incidence and, if available, risk of tumor recurrence are summarized for commonly used disease-modifying antirheumatic drugs. Finally, an attempt is made to formulate proposals for rheumatological treatment in patients with a history of malignancy.
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Affiliation(s)
- Marc Schmalzing
- Rheumatologie/Klinische Immunologie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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Seror R, Lafourcade A, De Rycke Y, Pinto S, Castaneda J, Fautrel B, Mariette X, Tubach F. Risk of malignancy in rheumatoid arthritis patients initiating biologics: an historical propensity score matched cohort study within the French nationwide healthcare database. RMD Open 2022; 8:rmdopen-2021-002139. [PMID: 35738803 PMCID: PMC9226991 DOI: 10.1136/rmdopen-2021-002139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/22/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the risk of malignancy between patients with rheumatoid arthritis (RA) initiating their first biological disease-modifying antirheumatic drug (bDMARD) and those continuing conventional synthetic DMARDs (csDMARDs). Methods Nine-year historical Propensity Score (PS) matched cohort study within the French national healthcare database (87% of the French population; ~57 million people), including adults RA without malignancy. Exposures started with the first use of any systemic treatment (csDMARDs and/or bDMARDs). Incident users of bDMARDs were matched on a dynamic PS to patients continuing csDMARDs. Their risk of malignancy was compared by Cox model. Results From 1 January 2007 to 31 December 2014, 83 706 patients with RA started their first systemic treatment (63 837 remained on csDMARDs and 19 869 initiated a bDMARD during follow-up). After dynamic PS matching, 19 727 bDMARD initiators were compared with 19 727 RA remaining on csDMARDs. They did not statistically differ in risk of overall malignancies (HR 0.99 (95% CI 0.86 to 1.14)), solid cancer (HR 0.95 (95% CI 0.82 to 1.11)), nor lymphoma (HR 1.35 (95% CI 0.72 to 2.53)). Results were similar when bDMARDs were given as monotherapy or in association with csDMARDs. Analyses restricted to patients starting TNF inhibitor as first bDMARD compared with matched RA remaining on csDMARDs, provided similar results (HR for overall malignancy 1.03 (95% CI 0.88 to 1.21)). Sensitivity analyses, varying carry-over periods (up to 5 years) to define risk periods, provided similar results. Conclusions In this historical cohort study within the French nationwide healthcare database, the risk of overall, solid or haematological malignancies did not significantly differ between patients with RA initiating bDMARD and those continuing csDMARDs.
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Affiliation(s)
- Raphaele Seror
- Service de Rhumatologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Université Paris-Saclay, FHU CARE, Le Kremlin-Bicetre, France .,INSERM UMR 1184, Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicetre, France
| | - Alexandre Lafourcade
- Centre de Pharmacoépidémiologie (Cephepi), AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Yann De Rycke
- Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, Sorbonne Université, Faculté de médecine Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,Institut Pierre Louis d'epidemiologie, Sorbonne University, INSERM UMR-S 1136, Paris, France
| | - Sandrine Pinto
- Institut Pierre Louis d'epidemiologie, Sorbonne University, INSERM UMR-S 1136, Paris, France
| | - Johann Castaneda
- Centre de Pharmacoépidémiologie (Cephepi), AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Bruno Fautrel
- Institut Pierre Louis d'epidemiologie, Sorbonne University, INSERM UMR-S 1136, Paris, France.,Service de Rhumatologie, Sorbonne Université, AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
| | - Xavier Mariette
- Service de Rhumatologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Université Paris-Saclay, FHU CARE, Le Kremlin-Bicetre, France.,INSERM UMR 1184, Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicetre, France
| | - Florence Tubach
- Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, Sorbonne Université, Faculté de médecine Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,Institut Pierre Louis d'epidemiologie, Sorbonne University, INSERM UMR-S 1136, Paris, France.,delete this affiliaton, Paris, France
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Huss V, Bower H, Wadström H, Frisell T, Askling J. Short- and longer-term cancer risks with biologic and targeted synthetic disease-modifying antirheumatic drugs as used against rheumatoid arthritis in clinical practice. Rheumatology (Oxford) 2022; 61:1810-1818. [PMID: 34324640 PMCID: PMC9071561 DOI: 10.1093/rheumatology/keab570] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/05/2021] [Indexed: 11/14/2022] Open
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.
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Affiliation(s)
- Viking Huss
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Rheumatology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Hannah Bower
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Hjalmar Wadström
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Rheumatology, Karolinska University Hospital Solna, Stockholm, Sweden
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46
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Bower H, Frisell T, Di Giuseppe D, Delcoigne B, Askling J. Influenza outcomes in patients with inflammatory joint diseases and DMARDs: how do they compare to those of COVID-19? Ann Rheum Dis 2022; 81:433-439. [PMID: 34810197 PMCID: PMC8610614 DOI: 10.1136/annrheumdis-2021-221461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate absolute and relative risks for seasonal influenza outcomes in patients with inflammatory joint diseases (IJDs) and disease-modifying antirheumatic drugs (DMARDs). To contextualise recent findings on corresponding COVID-19 risks. METHODS Using Swedish nationwide registers for this cohort study, we followed 116 989 patients with IJD and matched population comparators across four influenza seasons (2015-2019). We quantified absolute risks of hospitalisation and death due to influenza, and compared IJD to comparators via Cox regression. We identified 71 556 patients with IJD on active treatment with conventional synthetic DMARDs and biological disease-modifying antirheumatic drugs (bDMARDs)/targeted synthetic disease-modifying antirheumatic drug (tsDMARDs) at the start of each influenza season, estimated risks for the same outcomes and compared these risks across DMARDs via Cox regression. RESULTS Per season, average risks for hospitalisation listing influenza were 0.25% in IJD and 0.1% in the general population, corresponding to a crude HR of 2.38 (95% CI 2.21 to 2.56) that decreased to 1.44 (95% CI 1.33 to 1.56) following adjustments for comorbidities. For death listing influenza, the corresponding numbers were 0.015% and 0.006% (HR=2.63, 95% CI 1.93 to 3.58, and HR=1.46, 95% CI 1.07 to 2.01). Absolute risks for influenza outcomes were half (hospitalisation) and one-tenth (death) of those for COVID-19, but relative estimates comparing IJD to the general population were similar. CONCLUSIONS In absolute terms, COVID-19 in IJD outnumbers that of average seasonal influenza, but IJD entails a 50%-100% increase in risk for hospitalisation and death for both types of infections, which is largely dependent on associated comorbidities. Overall, bDMARDs/tsDMARDs do not seem to confer additional risk for hospitalisation or death related to seasonal influenza.
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Affiliation(s)
- Hannah Bower
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bénédicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Jin Y, Kang Y, Wang M, Wu B, Su B, Yin H, Tang Y, Li Q, Wei W, Mei Q, Hu G, Lukacs-Kornek V, Li J, Wu K, Yuan X, Wang W. Targeting polarized phenotype of microglia via IL6/JAK2/STAT3 signaling to reduce NSCLC brain metastasis. Signal Transduct Target Ther 2022; 7:52. [PMID: 35194016 PMCID: PMC8864012 DOI: 10.1038/s41392-022-00872-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 12/27/2022] Open
Abstract
Tumor-associated macrophages have emerged as crucial factors for metastases. Microglia are indispensable components of the brain microenvironment and play vital roles in brain metastasis (BM). However, the underlying mechanism of how activated microglia promote brain metastasis of non-small cell lung cancer (NSCLC) remains elusive. Here, we purified cell lines with brain-metastatic tropism and employed a co-culture system to reveal their communication with microglia. By single-cell RNA-sequencing and transcriptome difference analysis, we identified IL6 as the key regulator in brain-metastatic cells (A549-F3) to induce anti-inflammatory microglia via JAK2/STAT3 signaling, which in turn promoted the colonization process in metastatic A549-F3 cells. In our clinical samples, patients with higher levels of IL6 in serum showed higher propensity for brain metastasis. Additionally, the TCGA (The Cancer Genome Atlas) data revealed that NSCLC patients with a lower level of IL6 had a longer overall survival time compared to those with a higher level of IL6. Overall, our data indicate that the targeting of IL6/JAK2/STAT3 signaling in activated microglia may be a promising new approach for inhibiting brain metastasis in NSCLC patients.
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Affiliation(s)
- Yu Jin
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Yalin Kang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Minghuan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Bili Wu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Beibei Su
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Han Yin
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Yang Tang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Qianxia Li
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Wenjie Wei
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Qi Mei
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Guangyuan Hu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Veronika Lukacs-Kornek
- Institute of Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Jian Li
- Institute of Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Kongming Wu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Xianglin Yuan
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China.
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China.
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A Review of Safety Outcomes from Clinical Trials of Baricitinib in Rheumatology, Dermatology and COVID-19. Adv Ther 2022; 39:4910-4960. [PMID: 36063279 PMCID: PMC9443639 DOI: 10.1007/s12325-022-02281-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/21/2022] [Indexed: 01/30/2023]
Abstract
Baricitinib is an oral, selective inhibitor of Janus kinase (JAK)1/JAK2 that transiently and reversibly inhibits many proinflammatory cytokines. This mechanism is a key mediator in a number of chronic inflammatory diseases; accordingly, baricitinib has been studied and approved for the treatment of several rheumatological and dermatological disorders, as well as COVID-19. This narrative review summarises and discusses the safety profile of baricitinib across these diseases, with special focus on adverse events of special interest (AESI) for JAK inhibitors, using integrated safety data sets of clinical trial data, and puts findings into context with the underlying risk in the respective disease populations, using supporting literature. We show that rates of infection with baricitinib generally reflected the inherent risk of the disease populations being treated, with serious infections and herpes zoster being more frequent in rheumatic diseases than in dermatological disorders, and herpes simplex being reported particularly in atopic dermatitis. Similarly, rates of major adverse cardiovascular events (MACE), venous thromboembolism (VTE) and malignancies were generally within or below the ranges reported for the respective disease populations, thereby reflecting the underlying risk; these events were therefore more frequent in patients with rheumatic diseases than in those with dermatological disorders, the latter of whom generally had low absolute risk. AESI were usually more common in patients with risk factors specific for each event. When a population similar to that of ORAL Surveillance was considered, the incidence rate of MACE with baricitinib was numerically lower than that reported with tofacitinib and similar to that of tumour necrosis factor inhibitors. No safety concerns were observed in hospitalised patients with COVID-19 who received baricitinib for up to 14 days. Identifying the patterns and likelihoods of AEs that occur during treatment in large groups of patients with different diseases can help the physician and patient better contextualise the benefit-to-risk ratio for the individual patient.
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Chisari CG, Sgarlata E, Arena S, Toscano S, Luca M, Patti F. Rituximab for the treatment of multiple sclerosis: a review. J Neurol 2022; 269:159-183. [PMID: 33416999 PMCID: PMC7790722 DOI: 10.1007/s00415-020-10362-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 01/07/2023]
Abstract
In the last decades, evidence suggesting the direct or indirect involvement of B cells on multiple sclerosis (MS) pathogenesis has accumulated. The increased amount of data on the efficacy and safety of B-cell-depleting therapies from several studies has suggested the addition of these drugs as treatment options to the current armamentarium of disease modifying therapies (DMTs) for MS. Particularly, rituximab (RTX), a chimeric monoclonal antibody directed at CD20 positive B lymphocytes resulting in cell-mediated apoptosis, has been demonstrated to reduce inflammatory activity, incidence of relapses and new brain lesions on magnetic resonance imaging (MRI) in patients with relapsing-remitting MS (RRMS). Additional evidence also demonstrated that patients with progressive MS (PMS) may benefit from RTX, which also showed to be well tolerated, with acceptable safety risks and favorable cost-effectiveness profile.Despite these encouraging results, RTX is currently approved for non-Hodgkin's lymphoma, chronic lymphocytic leukemia, several forms of vasculitis and rheumatoid arthritis, while it can only be administered off-label for MS treatment. Between Northern European countries exist different rules for using not licensed drug for treating MS. The Sweden MS register reports a high rate (53.5%) of off-label RTX prescriptions in relation to other annually started DMTs to treat MS patients, while Danish and Norwegian neurologists have to use other anti-CD20 drugs, as ocrelizumab, in most of the cases.In this paper, we review the pharmacokinetics, pharmacodynamics, clinical efficacy, safety profile and cost effectiveness aspects of RTX for the treatment of MS. Particularly, with the approval of new anti-CD20 DMTs, the recent worldwide COVID-19 emergency and the possible increased risk of infection with this class of drugs, this review sheds light on the use of RTX as an alternative treatment option for MS management, while commenting the gaps of knowledge regarding this drug.
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Affiliation(s)
- Clara Grazia Chisari
- Department "GF Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Eleonora Sgarlata
- Department "GF Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
- Stroke Unit, Department of Medicine, Umberto I Hospital, Siracusa, Italy
| | - Sebastiano Arena
- Department "GF Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Simona Toscano
- Department "GF Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Maria Luca
- Department "GF Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Francesco Patti
- Department "GF Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
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Takabayashi K, Ando F, Ikeda K, Fujita S, Nakajima H, Hanaoka H, Suzuki T. Trend in Prescription and Treatment Retention of Molecular-Targeted Drugs in 121,131 Japanese Patients With Rheumatoid Arthritis: A Population-Based Real-World Study. Mod Rheumatol 2021; 32:857-865. [PMID: 34907436 DOI: 10.1093/mr/roab126] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe the real-world prescription and treatment retention of molecular-targeted drugs for rheumatoid arthritis (RA) in Japan. MATERIALS AND METHODS 204,416 patients with RA prescribed at least one of the eight molecular-targeted drugs in 7 years from the National Database of Health Insurance Claims and Specific Health Checkups of Japan covering 98.3% of the Japanese population. The retention rate of each drug as well as head-to head comparisons were estimated by Kaplan-Meier method. RESULTS 121,131 RA patients were prescribed any molecular-targeted drug for the first time, while 36,633 uses of molecular-targeted drug switched from another (switch use). The overall retention rates of molecular-targeted drugs at 12, 36, and 60 months were 0.64, 0.42, and 0.32 for the naïve use and 0.59, 0.40, and 0.31 for the switch use, respectively. Non-tumor necrosis factor (TNF)-inhibitor molecular-targeted drugs, particularly tocilizumab and tofacitinib, had higher retention rates than TNF inhibitors for both naïve and switch uses regardless of the previous drug, and showed higher retention rates in head-to-head comparisons between eight molecular-targeted drugs. CONCLUSIONS Our data reveal that the real-world drug retention is overall lower than previously reported and higher with non-TNF inhibitors than with TNF inhibitors.
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Affiliation(s)
- Katsuhiko Takabayashi
- Department of Internal Medicine, Sanwa Hospital, Chiba, Japan.,Division of Medical Informatics and Management, Chiba University Hospital, Chiba, Japan
| | - Fumihiko Ando
- Division of Medical Informatics and Management, Chiba University Hospital, Chiba, Japan
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Shinsuke Fujita
- Department of Clinical Design and Medicine, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takahiro Suzuki
- Division of Medical Informatics and Management, Chiba University Hospital, Chiba, Japan
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