Division of Rheumatology, University of Washington.
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Curr Opin Rheumatol. 2021 May 1;33(3):292-299. doi: 10.1097/BOR.0000000000000796.
Several new therapeutic drugs are now available for the management of rheumatoid arthritis (RA). Given that RA has been associated with an increased risk of certain cancers like lymphoma and lung cancer, concern remains about the safety of (newer) immunosuppressants used in RA management as it relates to the risk of cancer.
Most meta-analyses of randomized clinical trials of tumor necrosis factor inhibitors (TNFi) have not observed an association between TNFi and risk of incident cancer. Studies of non-TNFi biologic disease modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs and cancer are also reassuring but limited and of short-term follow-up. Regarding the use of DMARDs in patients with RA and a prior malignancy, retrospective studies have shown that TNFi use is not associated with recurrence.
There is a need for ongoing studies on the safety of non-TNFi bDMARDs and targeted synthetic disease modifying anti-rheumatic drugs and recurrent cancer. Further research is also needed to guide the patients, rheumatologists, and oncologists regarding the safest DMARDs to choose for patients with RA and a recent diagnosis of cancer.
目前有几种新的治疗药物可用于治疗类风湿关节炎（RA）。鉴于 RA 与某些癌症（如淋巴瘤和肺癌）的风险增加相关，人们仍然关注 RA 治疗中使用的（新型）免疫抑制剂的安全性，因为这与癌症风险有关。
大多数肿瘤坏死因子抑制剂（TNFi）的随机临床试验的荟萃分析都没有观察到 TNFi 与癌症发病风险之间的关联。对非 TNFi 生物性疾病修饰抗风湿药物（bDMARDs）和靶向合成 DMARDs 与癌症的研究也令人安心，但这些研究有限且随访时间短。关于在有先前恶性肿瘤的 RA 患者中使用 DMARDs 的问题，回顾性研究表明，TNFi 的使用与复发无关。
需要对非 TNFi bDMARDs 和靶向合成疾病修饰抗风湿药物以及复发性癌症的安全性进行持续研究。还需要进一步研究，以指导患者、风湿病学家和肿瘤学家为最近诊断患有癌症的 RA 患者选择最安全的 DMARDs。
