Joo Young Bin, Jeong Seung Min, Park Yune-Jung, Kim Ki-Jo, Park Kyung-Su
Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Rheum Dis. 2022 Jul 1;29(3):162-170. doi: 10.4078/jrd.2022.29.3.162.
There is no recommendation for the use of disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA) who developed cancer. We examined changes in the DMARDs prescription patterns associated with cancer diagnosis in RA patients.
We reviewed the medical records of 2,161 RA patients who visited rheumatology clinic between January 2008 and February 2017 and found 40 patients who developed cancer during RA treatment. In these patients, we examined DMARDs prescription patterns before and right after cancer diagnosis and at recent outpatient clinic visits.
Before cancer diagnosis, methotrexate (MTX)-combined conventional synthetic DMARDs (csDMARDs) were most commonly prescribed (22, 55.0%) and biological DMARDs (biologics) in nine patients (22.5%). For cancer treatment, 19 patients received chemotherapy (including adjuvant chemotherapy) and 21 patients had surgery only. Right after cancer diagnosis, changes in the DMARDs prescription patterns were similar in discontinuation (13, 32.5%), switching (14, 35.0%), and maintenance (13, 32.5%). DMARDs were discontinued more frequently in the chemotherapy group (9/19, 47.4%) than the surgery only group (4/2, 19.0%) (p<0.05). Among the 13 patients who discontinued DMARDs, nine (69.2%) resumed DMARDs after a median of 5.5 months (interquartile range [IQR] 2.9, 18.3) due to arthritis flare. At a median of 4.6 years (IQR 3.3, 6.7) after cancer diagnosis, 25 patients were evaluated at recent outpatient clinic visits. Four patients received no DMARD, three MTX monotherapies, 11 csDMARDs combination therapies, and seven biologics.
A significant number of RA patients who developed cancer during RA treatment were still receiving DMARDs including biologics after cancer diagnosis.
对于已患癌症的类风湿关节炎（RA）患者，尚无使用改善病情抗风湿药物（DMARDs）的推荐意见。我们研究了RA患者中与癌症诊断相关的DMARDs处方模式的变化。
我们回顾了2008年1月至2017年2月期间到风湿病门诊就诊的2161例RA患者的病历，发现40例患者在RA治疗期间患癌。在这些患者中，我们研究了癌症诊断前、诊断刚结束时以及最近一次门诊就诊时的DMARDs处方模式。
在癌症诊断前，最常处方的是甲氨蝶呤（MTX）联合传统合成DMARDs（csDMARDs）（22例，55.0%），9例（22.5%）使用生物DMARDs（生物制剂）。对于癌症治疗，19例患者接受了化疗（包括辅助化疗），21例患者仅接受了手术。在癌症诊断刚结束时，DMARDs处方模式在停药（13例，32.5%）、换药（14例，35.0%）和维持用药（13例，32.5%）方面的变化相似。化疗组中DMARDs停药的频率（9/19，47.4%）高于仅接受手术组（4/21，19.0%）（p<0.05）。在13例停用DMARDs的患者中，9例（69.2%）在因关节炎发作停药中位时间5.5个月（四分位间距[IQR]2.9，18.3）后恢复使用DMARDs。在癌症诊断后中位时间4.6年（IQR 3.3，6.7）时，对25例患者进行了最近一次门诊评估。4例患者未使用DMARDs，3例使用MTX单药治疗，11例使用csDMARDs联合治疗，7例使用生物制剂。
相当数量的在RA治疗期间患癌的RA患者在癌症诊断后仍在接受包括生物制剂在内的DMARDs治疗。
