Time Dependent Effect of Biologic Therapy on Overall Survival in Patients with Rheumatoid Arthritis and Cancer

Xerxes Pundole¹, Natalia Zamora², Harish Siddhanamatha³, Jean Tayar⁴, Cheuk Hong Leung⁵, Heather Lin⁶ and Maria Suarez-Almazor⁷, ¹Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, Houston, TX, ²Reumatologia, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, Buenos Aires, Argentina, ³The University of Texas Health Science Center, School of Biomedical Informatics, Houston, TX, USA, Houston, TX, ⁴Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA, Houston, TX, ⁵Department of Biostatistics, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, Houston, TX, ⁶Biostatistics, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, Houston, TX, ⁷Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Biologic agents, Cancer, DMARDs, rheumatoid arthritis (RA) and tumor necrosis factor (TNF)

Session Information

Date: Monday, October 22, 2018

Title: Rheumatoid Arthritis – Treatments Poster II: PROs, Safety and Comorbidity

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:

Biologic disease-modifying anti-rheumatic drugs (bDMARDs) are commonly used in the treatment of rheumatoid arthritis (RA). But the use of bDMARDs in patients with RA and cancer is controversial.

Methods:

We performed a retrospective cohort study of patients with prevalent RA and cancer seen at MD Anderson Cancer Center between 2002 and 2014. Cancer patients were identified from the institutional tumor registry and RA patients were identified through ICD-9 codes and verified by chart review. Patients were followed until 2016 to assess overall survival (OS). We built Cox Proportional Hazard regression models using bDMARD therapy as a time-varying covariate.

Results:

We identified 431 patients with RA of which 111 received bDMARDs at various times after a cancer diagnosis. Of these 111 patients, 60 received bDMARDs prior to the cancer diagnosis and remained on bDMARDs following the cancer diagnosis. In a multivariable model stratified by tumor type and stage and after adjusting for age at diagnosis, OS in patients that received tumor necrosis factor (TNF) inhibitors was compared to patients who never received bDMARDs with a hazard ratio (HR) of 0.67 (95% confidence interval (CI), 0.31, 1.44). Patients who received non-TNF bDMARDs had a HR of 1.10 (95% CI, 0.26, 4.60) compared to those without treatment. These differences were not statistically significant (overall effect p=0.58). We evaluated the effects of bDMARDs in a subgroup of 175 breast cancer patients (the largest subgroup, to remove the confounding effect of tumor type on OS) with RA. Of these patients 25% (n=44) received bDMARDs, 35 received TNF inhibitors and 9 received non-TNF bDMARDs. Fifty-two percent of these patients were on bDMARDs prior to cancer and continued after a cancer diagnosis. Another 16% were started on bDMARDs within the first 5 years after cancer diagnosis and the remaining 32% received the first dose > 5 years after cancer diagnosis. Only two patients with distant stage received bDMARDs. In a multivariable model, after adjusting for age at diagnosis and tumor stage, compared to the patients who never received bDMARDs, the patients who received TNF inhibitors (HR, 1.21; 95% CI, 0.38, 3.87) or non-TNF bDMARDs (HR, 1.86; 95% CI, 0.34, 10.3) had inferior OS. However, these differences were not statistically significant (overall effect p=0.75).

Conclusion:

We did not observe any statistically significant differences in OS between those that received bDMARDs and those that did not in patients with RA and cancer. More research is necessary to evaluate the effects of bDMARDs in a larger sample of cancer patients, especially with respect to individual tumors, and also in those with early or advanced cancer.

Disclosure: X. Pundole, None; N. Zamora, None; H. Siddhanamatha, None; J. Tayar, None; C. H. Leung, None; H. Lin, None; M. Suarez-Almazor, None.

To cite this abstract in AMA style:

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 9). https://acrabstracts.org/abstract/time-dependent-effect-of-biologic-therapy-on-overall-survival-in-patients-with-rheumatoid-arthritis-and-cancer/. Accessed .

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