Actemra, TNF inhibitors yield similar malignancy risk in patients with RA
AMSTERDAM — No differences were reported in malignancy incidence between patients with rheumatoid arthritis newly treated with tocilizumab vs. TNF inhibitors, according to findings presented at the EULAR Annual Congress.
“While there are some studies on the risk of malignancy associated with use of TNF inhibitors, little is known with regard to the risk of malignancy associated with biologics other than TNF inhibitors such as tocilizumab,” Seoyoung C. Kim, MD, ScD, MSCE, from Brigham and Women’s Hospital and Harvard Medical School, told Healio Rheumatology.
To determine the rate of incident malignancy — excluding non-melanoma skin cancer — among patients with RA treated with either tocilizumab (Actemra, Genentech) or TNF inhibitors, Kim and colleagues conducted a cohort study using data from one of three U.S. health care claims databases: Medicare, IMS PharMetrics Plus or Truven Market-Scan. To control for confounding variables, the researchers propensity score-matched (1:3 variable ratio) patients with RA who started tocilizumab (n = 10,393) or TNF inhibitor (n = 26,357) after failing on abatacept (Orencia, Bristol-Myers Squibb), tofacitinib (Xeljanz, Pfizer) or another TNF inhibitor.
Kim and colleagues also analyzed the most frequently occurring cancers — including bladder, breast, colorectal, kidney, lung, prostate, thyroid and uterine — non-Hodgkin lymphoma, leukemia, HPV-related cancer and all-cause mortality as individual secondary endpoints. The researchers followed individuals up until treatment discontinuation, outcome occurrence, disenrollment, death or the conclusion of the study period.
Results indicated the incidence of malignancy per 100 person-years ranged from 0.83 to 2.32 in patients who received tocilizumab compared with 0.96 to 2.15 among patients who received TNF inhibitors.
“In this cohort study of nearly 40,000 RA patients, we found no difference in the risk of malignancy, excluding non-melanoma skin cancer, in patients who newly switched to tocilizumab vs. TNF inhibitor from a different TNF inhibitor, abatacept or tofacitinib,” Kim told Healio Rheumatology.
The researchers reported similar null findings regarding the incidence of common cancers, with no statistically significant differences in malignancy risk.
“Our study is one of a few to investigate head-to-head comparisons of malignancy risk between different types of biologics in RA,” Kim said. “Cancer risk associated with disease or treatment is something our patients are very much worried about [and] our study adds population-based evidence that is crucial in a medical decision-making for RA management.”– by Bob Stott
Kim SC, et al. Abstract OP0002. Presented at: EULAR Annual Congress; June 13-16, 2018; Amsterdam.
Disclosure: Kim reports grant/research support from Roche, Pfizer and Bristol-Myers Squibb. Please see the study for all other authors’ relevant financial disclosures.