Rheumatology Xagena

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Xagena Newsletter

Patients with rheumatoid arthritis: no difference in malignancy rates seen between Tocilizumab and TNF inhibitors

A study presented at the Annual European Congress of Rheumatology ( EULAR 2018 ) has examined rates of malignancy in patients with rheumatoid arthritis ( RA ), excluding non-melanoma skin cancer ( NMSC ), and found no difference between those newly treated with Tocilizumab ( Actemra, RoActemra ) versus TNF inhibitors ( TNFi ).

Rheumatoid arthritis is a chronic inflammatory disease that affects a person's joints, causing pain and disability. It can also affect internal organs.
Rheumatoid arthritis is more common in older people, but there is also a high prevalence in young adults, adolescents and even children, and it affects women more frequently than men.

Patients with rheumatoid arthritis have been shown to be at increased risk of developing certain malignancies, thought to be due to the immune dysregulation and/or chronic inflammation in rheumatoid arthritis.
Recently, biologic DMARDs ( bDMARDs ) have become available and there are some concerns regarding malignancy with their use, given their target-specific inhibition of the immune system.
However, there has been conflicting data regarding the influence of bDMARDs on malignancy.

The study examined the rate of incident malignancy, excluding NMSC, in patients with rheumatoid arthritis who were newly treated with either Tocilizumab or TNF inhibitor.

The study included adult patients with RA who had newly started on rheumatoid arthritis or a TNF inhibitor after failing on Abatacept, Tofacitinib or another TNFi.
Investigators used three healthcare claims databases ( Medicare, IMS ParMetrics Plus and Truven MarketScan ) from 2010-2015 to identify 10,393 Tocilizumab initiators who were propensity score matched ( 1:3 variable ratio ) to 26,357 TNF inhibitor initiators.
This is a statistical matching technique that controls for over 60 potential baseline confounding variables.
Individuals were followed up until treatment discontinuation, outcome occurrence, disenrollment, death or the end of the study period.

The primary outcome was an incidence of malignancy ( excluding NMSC ) which were identified based on two diagnosis codes within two months.
The incidence of malignancy per 100 person-years ranged from 0.83 to 2.32 in Tocilizumab patients, and from 0.96 to 2.15 in TNF inhibitor patients between the different databases.

Statistical analysis revealed no significant differences between the groups.
In addition, there were no significant differences in the incidence of the ten most frequently occurring cancers and leukaemia or human papilloma virus-related cancer which were analysed as individual secondary endpoints. ( Xagena )

Source: European League Against Rheumatism ( EULAR ), 2018