Pundole Xerxes, Zamora Natalia V, Siddhanamatha Harish, Lin Heather, Tayar Jean, Leung Cheuk Hong, Li Liang, Suarez-Almazor Maria E
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
Sección Reumatología, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina.
Clin Rheumatol. 2020 Oct;39(10):2943-2950. doi: 10.1007/s10067-020-05318-7. Epub 2020 Aug 15.
INTRODUCTION/OBJECTIVES: The effects of biologic disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) and cancer are largely unknown. We examined overall survival (OS) in patients with RA and solid malignancies receiving bDMARDs.
We performed a retrospective cohort study of patients with RA and solid malignancies seen at MD Anderson Cancer Center between 2002 and 2014. Cox proportional hazard regression models, stratified by tumor type and stage, were fit evaluating use of bDMARDs as a time fixed and time varying covariate.
We identified 431 RA patients with solid malignancies: 111 (26%) received bDMARDs after their cancer diagnosis. Median OS from cancer diagnosis was 16.1 years. Of the patients receiving bDMARDs, most had localized disease, and only 14 (13%) had advanced cancer. In the stratified Cox models no statistically significant differences were observed between patients who received tumor necrosis factor inhibitors (TNFi) or patients who received nonTNFi, compared with those who did not receive bDMARDs (hazard ratio (HR), 0.67; 95% confidence interval (CI), 0.31, 1.44; HR, 1.10; 95% CI, 0.26, 4.60 respectively). In breast cancer patients, those receiving TNFi or nonTNFi had a numerically higher but statistically nonsignificant HR compared with those who did not receive bDMARD: HR, 1.40 (95% CI, 0.42, 4.73), and HR, 1.37 (95% CI, 0.22, 8.42) respectively.
No significant differences in OS were observed between patients who received bDMARDs and those who did not. Additional data is needed to evaluate other cancer outcomes such as recurrence and progression, and patients with advanced cancer. Key Points •We found no statistically significant differences in OS between patients with RA and concomitant solid malignancies who received bDMARDs and those who did not. •Most patients who received bDMARDs had been diagnosed with early stage cancer •As few patients with advanced cancer received bDMARDs safety for this group cannot be established •No significant differences were observed between TNFi and nonTNFi, but the sample size was small.
引言/目的：生物性病情缓解抗风湿药物（bDMARDs）对类风湿关节炎（RA）合并癌症患者的影响尚不清楚。我们研究了接受bDMARDs治疗的RA合并实体恶性肿瘤患者的总生存期（OS）。
我们对2002年至2014年间在MD安德森癌症中心就诊的RA合并实体恶性肿瘤患者进行了一项回顾性队列研究。采用Cox比例风险回归模型，按肿瘤类型和分期分层，将bDMARDs的使用作为固定时间和可变时间协变量进行评估。
我们确定了431例RA合并实体恶性肿瘤患者：111例（26%）在癌症诊断后接受了bDMARDs治疗。从癌症诊断开始的中位总生存期为16.1年。在接受bDMARDs治疗的患者中，大多数患有局限性疾病，只有14例（13%）患有晚期癌症。在分层Cox模型中，接受肿瘤坏死因子抑制剂（TNFi）的患者或接受非TNFi的患者与未接受bDMARDs的患者相比，未观察到统计学上的显著差异（风险比（HR）分别为0.67；95%置信区间（CI）为0.31，1.44；HR为1.10；95%CI为0.26，4.60）。在乳腺癌患者中，接受TNFi或非TNFi的患者与未接受bDMARDs的患者相比，HR在数值上更高，但无统计学意义：HR分别为1.40（95%CI为0.42，4.73）和1.37（95%CI为0.22，8.42）。
接受bDMARDs治疗的患者与未接受bDMARDs治疗的患者在总生存期方面未观察到显著差异。需要更多数据来评估其他癌症结局，如复发和进展，以及晚期癌症患者。要点：•我们发现，接受bDMARDs治疗的RA合并实体恶性肿瘤患者与未接受治疗的患者在总生存期方面无统计学显著差异。•大多数接受bDMARDs治疗的患者被诊断为早期癌症。•由于很少有晚期癌症患者接受bDMARDs治疗，因此无法确定该组患者的安全性。•TNFi和非TNFi之间未观察到显著差异，但样本量较小。
