Abstract
Objective Recently issued guidelines suggest rheumatoid arthritis (RA) patients with previously treated solid malignancy may be treated as patients without such history. The recommendation is based on limited evidence and rheumatologists and patients are frequently hesitant to start or continue biologic therapy. The objective of this study was to describe biologic utilization in real-world RA patients following a malignancy diagnosis.
Methods RA patients enrolled in Corrona diagnosed with solid malignancy with at least 1 follow-up visit within 12 months after diagnosis were included in this analysis. The proportion of patients continuing or initiating biologic/targeted synthetic disease-modifying antirheumatic drug (bDMARD/tsDMARD) after diagnosis was estimated. Median time to initiation of biologic/tsDMARD after diagnosis was calculated using the Kaplan-Meier method and proportion initiating biologic treatment in 6-month time intervals was estimated using the life-table method.
Results 880 patients met inclusion criteria with 2,585 person-years total follow-up time post-diagnosis. 367 of 880 patients (41.7%) were treated with biologics/tsDMARDs within 12 months preceding malignancy, of which 270 (30.7%) were on such agents at first post-diagnosis visit. 44 (5%) switched biologic agents within 36 months and an additional 90 patients (10.2%) started a biologic. The majority of biologic/tsDMARD initiations during follow-up were a TNF inhibitor (TNFi) (53.5%).
Conclusion In real-world practice, nearly one-third of RA patients with a cancer diagnosis were treated with systemic therapy in the immediate visit after malignancy diagnosis and a considerable percentage of malignancy survivors initiated biologic therapy within 3 years. The majority of biologic/tsDMARD initiations post- malignancy diagnosis was a TNFi.