Westermann Rasmus, Cordtz René Lindholm, Duch Kirsten, Mellemkjaer Lene, Hetland Merete Lund, Magnussen Bergur, Dreyer Lene
Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark.
Clinical Cancer Research Unit, Aalborg University Hospital, Aalborg, Denmark.
Rheumatology (Oxford). 2025 Mar 1;64(3):1019-1028. doi: 10.1093/rheumatology/keae140.
To investigate cancer risk in RA patients treated with tocilizumab/sarilumab, abatacept or rituximab compared with those who received TNF inhibitors (TNFi) and compared with biological DMARDs (bDMARD)-naïve RA patients.
Nationwide registry-based cohort study of RA patients who initiated bDMARD treatment with tocilizumab/sarilumab, abatacept, rituximab, and TNFi, as well as bDMARD-naive patients who initiated their second type of conventional synthetic DMARD. Patients were identified in the Danish Rheumatology Quality Register (DANBIO) and followed for cancer from 2006 to 2020. Patients could contribute multiple treatments, with person years, deaths and cancers allocated to each treatment group in a 'latest type of treatment' manner. Inverse probability of treatment weighting and weighted cause-specific Cox models were used to calculate hazard ratios (HRs) for cancer in each tocilizumab/sarilumab, abatacept and rituximab group compared with TNFi-treated and bDMARD-naïve groups, respectively.
In total, 21 982 treatment initiations, 96 475 person years and 1423 cancers were identified. There were no statistically significant increased HRs for overall cancer in tocilizumab/sarilumab, abatacept or rituximab treatment groups (HRs ranged from 0.7 to 1.1). More than 5 years of abatacept exposure showed a non-significantly increased HR compared with TNFi (HR 1.41, 95% CI 0.74-2.71). For haematological cancers, rituximab treatment showed non-significantly reduced HRs: vs TNFi-treated (HR 0.09; 95% CI 0.00-2.06) and bDMARD-naïve (HR 0.13; 95% CI 0.00-1.89).
Treatment with tocilizumab/sarilumab, abatacept or rituximab in RA patients was not associated with increased risks of cancer compared with TNFi-treated and with bDMARD-naïve RA patients in a real-world setting.
研究与接受肿瘤坏死因子抑制剂（TNFi）治疗的类风湿关节炎（RA）患者以及未使用生物改善病情抗风湿药（bDMARD）的RA患者相比，使用托珠单抗/萨瑞鲁单抗、阿巴西普或利妥昔单抗治疗的RA患者的癌症风险。
基于全国登记的队列研究，纳入开始使用托珠单抗/萨瑞鲁单抗、阿巴西普、利妥昔单抗和TNFi进行bDMARD治疗的RA患者，以及开始使用第二种传统合成抗风湿药的未使用bDMARD的患者。在丹麦风湿病质量登记处（DANBIO）中识别患者，并从2006年至2020年对其癌症情况进行随访。患者可能接受多种治疗，以“最新治疗类型”的方式将人年数、死亡数和癌症病例分配到每个治疗组。使用治疗权重的逆概率和加权病因特异性Cox模型分别计算托珠单抗/萨瑞鲁单抗、阿巴西普和利妥昔单抗各治疗组与TNFi治疗组和未使用bDMARD组相比的癌症风险比（HR）。
共识别出21982次治疗起始、96475人年和1423例癌症。托珠单抗/萨瑞鲁单抗、阿巴西普或利妥昔单抗治疗组的总体癌症HR没有统计学显著升高（HR范围为0.7至1.1）。与TNFi相比，接受阿巴西普治疗超过5年的患者HR有非显著升高（HR 1.41，95%置信区间0.74 - 2.71）。对于血液系统癌症，利妥昔单抗治疗显示HR有非显著降低：与TNFi治疗组相比（HR 0.09；95%置信区间0.00 - 2.06）以及与未使用bDMARD组相比（HR 0.13；95%置信区间0.00 - 1.89）。
在现实环境中，与接受TNFi治疗的RA患者以及未使用bDMARD的RA患者相比，使用托珠单抗/萨瑞鲁单抗、阿巴西普或利妥昔单抗治疗RA患者与癌症风险增加无关。
