Overall survival in patients with rheumatoid arthritis and solid malignancies receiving biologic disease-modifying antir
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ORIGINAL ARTICLE
Overall survival in patients with rheumatoid arthritis and solid malignancies receiving biologic disease-modifying antirheumatic therapy Xerxes Pundole 1 & Natalia V. Zamora 2 & Harish Siddhanamatha 3 & Heather Lin 4 & Jean Tayar 5 & Cheuk Hong Leung 4 & Liang Li 4 & Maria E. Suarez-Almazor 1,5 Received: 11 June 2020 / Revised: 24 July 2020 / Accepted: 4 August 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract 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. Methods 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. Results 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. Conclusion 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. Prior abstract publication Part of the data of this project was presented as a poster at the 2018 American College of Rheumatology annual meeting. Pundole X, Zamora N, Siddhanamatha H, Tayar J, Leung CH, Lin H, Suarez-Almazor M. Time Dependent Effect of Biologic Therapy on Overall Survival in Patients with Rheumatoid Arthritis and Cancer [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/ abstract/time-dependent-effect-of-biologic-therapy-on-overall-survivalin-patients-with-rheumatoid-arthritis-and-cancer/. Accessed November 11, 2019 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10067-020-05318-7) contains supplementary material, which is available to authorized users. * Maria E. Suarez-Almazor [email protected] 1
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe B
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