系统性文献综述与荟萃分析为欧洲抗风湿病联盟（EULAR）提供信息，以指导对有癌症病史的炎性关节炎患者启动靶向治疗时需考虑的要点。

Systematic literature review and meta-analysis informing the EULAR points to consider on the initiation of targeted therapies in patients with inflammatory arthritis and a history of cancer.

作者信息

Sebbag Eden, Molina-Collada Juan, Ndoye Ramatoulaye, Aletaha Daniel, Askling Johan, Gente Karolina, Bertheussen Heidi, Bitoun Samuel, Bolek Ertugrul Cagri, Buch Maya H, Burmester Gerd R, Canhão Helena M, Chatzidionysiou Katerina, Curtis Jeffrey R, Danlos Francois-Xavier, Guimarães Vera, Hetland Merete Lund, Iannone Florenzo, Kostine Marie, Kragstrup Tue Wenzel, Kvien Tore K, Regierer Anne Constanze, Schulze-Koops Hendrik, Sedmak Nathanaël, Silva-Fernández Lucía, Szekanecz Zoltan, Lauper Kim, Finckh Axel, Gottenberg Jacques-Eric

机构信息

Department of Rheumatology, Centre National de Référence des Maladies Auto-Immunes Rares, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.

Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain. Electronic address: https://x.com/jmolinacollada.

出版信息

Ann Rheum Dis. 2025 Apr;84(4):643-652. doi: 10.1136/ard-2024-225981. Epub 2025 Jan 31.

DOI:10.1136/ard-2024-225981

PMID:39739386

Abstract

BACKGROUND

Targeted therapies have been associated with potential risk of malignancy, which is a common concern in daily rheumatology practice in patients with inflammatory arthritis (IA) and a history of cancer.

OBJECTIVES

To perform a systematic literature review to inform a Task Force formulating EULAR points to consider on the initiation of targeted therapies in patients with IA and a history of cancer.

METHODS

Specific research questions were defined within the Task Force before formulating the exact research queries with a librarian. We included studies reporting a relative risk measure of patients with a history of cancer initiating a targeted therapy or a conventional synthetic disease-modifying antirheumatic drug (csDMARD), regardless of the time since diagnosis of cancer. All relevant studies included in PubMed or Embase up to 15 July 2022 were included. Two reviewers independently performed standardised article selection, data extraction, synthesis and risk of bias assessment.

RESULTS

14 published articles and one ACR abstract fulfilled the inclusion criteria. All studies were high-quality observational studies, representing a median follow-up from treatment initiation of 4.52 years among 4428 patients and 15 062 patient-years of follow-up for new or recurrent cancer. All patients had a history of cancer, most frequently solid cancer, most frequently receiving treatment for rheumatoid arthritis and most frequently treated with tumour necrosis factor-alpha inhibitors. Across these studies, the overall HR of new incident cancer or cancer recurrence was 0.90 (95% CI 0.74 to 1.10) for patients receiving a targeted therapy versus a csDMARD.

CONCLUSION

Overall, the targeted therapies and clinical contexts covered by the included studies were not associated with an increased risk of new incident cancer or cancer recurrence as compared with csDMARDs.

摘要

背景

靶向治疗与潜在的恶性肿瘤风险相关，这是炎症性关节炎（IA）患者且有癌症病史的日常风湿病诊疗中常见的关注点。

目的

进行系统的文献综述，为一个特别工作组提供信息，以制定欧洲抗风湿病联盟（EULAR）关于IA且有癌症病史患者开始靶向治疗时需考虑的要点。

方法

在与一名图书管理员确定确切的研究问题之前，特别工作组内定义了具体的研究问题。我们纳入了报告有癌症病史患者开始靶向治疗或传统合成改善病情抗风湿药物（csDMARD）的相对风险测量的研究，无论自癌症诊断后的时间。纳入了截至2022年7月15日在PubMed或Embase中收录的所有相关研究。两名评审员独立进行标准化的文章筛选、数据提取、综合及偏倚风险评估。

结果

14篇已发表文章和1篇美国风湿病学会（ACR）摘要符合纳入标准。所有研究均为高质量观察性研究，4428例患者从治疗开始的中位随访时间为4.52年，新发或复发癌症的随访患者年数为15062。所有患者均有癌症病史，最常见的是实体癌，最常接受类风湿关节炎治疗，最常使用肿瘤坏死因子-α抑制剂治疗。在这些研究中，接受靶向治疗的患者与接受csDMARD治疗的患者相比，新发癌症或癌症复发的总体风险比（HR）为0.90（95%置信区间0.74至1.10）。