Background/Purpose: Our objectives were to estimate and compare the incidence rate of malignancies associated with the different classes of biologics in RA patients.

Methods: We conducted an historical cohort study within the Frenchour national claim database, named SNIIRAM. Thisthat database prospectively records individual health resource use healthcare data  of 86% of the entire French population (65 million inhabitants) since 2007. RA adult patients were identified based on ICD-10 code (M05 or M06) recorded from long-term chronic disease status allowing for full medical reimbursement and/or hospital discharge summaries discharge between 2007-2016.  Patients with cancer history before biologic introduction were excluded.
Treatment exposures focused on incident first use of biologics including all anti-TNF, rituximab, abatacept, tocilizumab, ustekinumab, anakinra. To identify incident treatment periods, a one year period prior our period of analysis was analyzed; only patients that did not receive any biologics during this period were included.  Patients having previously receivedused only csDMARDs during observation period were included. For each individual, the index date was the first prescription of biologic to identify incident treatment periods. In the base case analysis, eExposure definition was considered with a 90-day latency after treatment initiation and a 180-day remanence period after drug discontinuation.
To compare the risk of malignancies between biologics, a propensity score (including age, sexe, year of first occurrence of RA code, date of treatment initiation, number of previous DMARDs, Charlson comorbidity index, diagnosis of tobacco and/or alcohol-associated disorders, number of hospitalisations for RA, cumulative corticosteroid dose) was constructed for each comparison. Hazard Ratios (HRs) for risk of cancer were estimated using Cox proportional hazards model with using propensity score inverse probability of treatment weighting (IPTW)weighting with stabilized weight. Since patients could have been exposed to different biologics, exposure was considered as a time-dependent variables and propensity score was estimated dynamically using pooled logistic regressionreassessed for each new exposure.  Sensitivity analyses are ongoing to assess the robustness of our results.

Results: Between 2007 and 2016, 31792 patients (112802 patient-years)- were exposed to biologics. The annual incidence rate of overall malignancies was 0.865 per 100 patients.  Malignancies occurred in 712 patients exposed to anti-TNF and 240 patients exposed to another biologic. The overall risk of malignancies and risk of lymphoma did not differ between anti-TNF and other biologics (analysed all together), or abatacept.  Within the anti-TNF class, the overall risk of malignancies and risk of lymphoma did not differ between etanercept and monoclonal anti-TNF.

Conclusion: Using a large nationwide healthcare database, representative of the French population, the overall risk of malignancies did not seem to differ across the different classes of biologic. Also, among anti-TNF, etanercept and monoclonal antibodies did not differ regarding the risk of malignancies including the risk of lymphoma.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-malignancies-across-biologic-classes-in-rheumatoid-arthritis-analysis-of-a-national-claim-database/