Background/Purpose: Although there are many studies about the association of disease-modifying anti-rheumatic drugs (DMARDs) with cancers in patients with rheumatoid arthritis (RA), there are few reports about the use of DMARDs after the diagnosis of cancers. The aim of this study is to investigate use of DMARDs after the diagnosis of cancer in patients with RA.

Methods: We did retrospective chart review of 2,164 patients with RA who visited our rheumatology outpatient clinic between Jan 2008 and Feb 2017. We examined the use of DMARDs in RA patients who were diagnosed as having cancers after the onset of RA both at the time of the initial diagnosis of cancers and at the recent outpatient visit.

Results:

We found out 53 patients who were diagnosed with cancers after the onset of RA. At the time of initial diagnosis of cancer, the median age was 67 years (interquartile range; 53, 75) and disease duration was 4.5 years (2.7, 4.5). Female was 37 (70%), seropositive patients were 47 (89%), and those with joint erosions were 28 (53%).

The most frequent cancer was lung cancer (n=12), followed by stomach cancer (n=6) and cervical cancer (n=6). Twenty-five (47%) received surgery, 20 (38%) received chemotherapy, and 8 (15%) received conservative treatment.

At the time of initial diagnosis of cancers, DMARDs were stopped in 22 patients (42%), but resumed in 15 within mean 1.5 months. In 17 patients (32%), DMARDs was changed and 11 of the 17 patients received monotherapy, among which hydroxychloroquine was most frequently used (n=5). Fourteen patients (26%) received the same DMARDs used before the diagnosis of cancer.

At the recent outpatient visit (after the mean follow-up of 2.7 years), conventional DMARDs were used in 32 patients (60%) and biologics in 7 (13%). Fourteen patients (27%) were not on the DMARDs treatment. When it comes to conventional DMARDs, monotherapy was used in 12 patients and combination DMARDs in 20. Methotrexate monotherapy (n=6/32) and the combination of leflunomide and hydroxychloroquine (n=6/32) were the most prevalent DMARDs.

After adjusting for confounding factors, chemotherapy was associated with no DMARDs treatment at a recent outpatient visit (odds ratio 4.6, 95% confidence interval 1.1-19.9). Interestingly, all the RA patients diagnosed with hematologic cancer (n=2) were not on the DMARD treatment.

Conclusion: In RA patients with cancer, main treatment patterns at the initial diagnosis of cancer were discontinuation of DMARDs or change to monotherapy mainly hydroxychloroquine. After the mean follow-up of 2.7 years, methotrexate monotherapy, combination of leflunomide and hydroxychloroquine, and biologics were used with nearly equal frequencies. Chemotherapy was associated with no DMARDs treatment at a recent outpatient visit.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-dmards-after-the-diagnosis-of-cancers-in-patients-with-ra/