Biologic DMARD usage almost flat since 2008 among patients with RA, breast cancer
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Key takeaways:
- Since 2008, there has been no “consistent increase” in the use of biologic DMARDs in patients with rheumatoid arthritis diagnosed with breast cancer.
- A lack of clear guidelines may be the reason.
Among patients with rheumatoid arthritis diagnosed with breast cancer, the utilization of TNF inhibitors and other biologic disease-modifying antirheumatic drugs has not risen for more than a decade, according to data published in Arthritis Care & Research.
“Physicians have been hesitant to prescribe biologics in patients with rheumatoid arthritis with a recent diagnosis of cancer,” Maria E. Suarez-Almazor, MD, PhD, Barnts Family Distinguished Professor at the University of Texas MD Anderson Cancer Center, told Healio. “In theory, the immunosuppression resulting from these therapies could hinder tumor immunity and cancer outcomes. Increasingly, new evidence from cohort studies and registries would suggest that biologics, and more specifically TNF inhibitors, do not seem to infer a risk for deleterious cancer outcomes in patients with RA and cancer.”
Given that new evidence, Suarez-Almazor and colleagues — including mentee Juan I. Ruiz, MD, MPH — aimed to see if there have been any changes in how often biologic DMARDs are used in patients with RA with recently diagnosed breast cancer. They performed a retrospective cohort study of 2,851 adults with both conditions and separately analyzed two cohorts: 1,412 privately insured patients from Optum’s de-identified Clinformatics Data Mart Database, and 1,439 patients from two Medicare-linked databases.
The study, published in Arthritis Care & Research, investigated the use of biologic DMARDs — including a separate analysis of the most commonly used type, TNF inhibitors — and glucocorticoids since 2008. Utilization patterns were analyzed in the 3 months prior to each breast cancer diagnosis, as well as use of the drugs for the following 3 years, starting at 3 months after diagnosis.
The analysis found no “consistent increase” in use of biologic DMARDs or TNF inhibitors since 2008, even as evidence for their safety in patients with cancer has mounted, the researchers wrote. In both the Medicare and privately insured cohorts, the largest independent predictor of DMARDs, biologic DMARDs or TNF inhibitors being utilized after breast cancer diagnosis was use of the drugs in the 3 months prior to diagnosis.
About 70% of patients in both cohorts used glucocorticoids within 3 years of their breast cancer diagnosis, with no significant trend over time. The researchers wrote that the glucocorticoid use “may be concerning” for tumor immunity due to the drug’s immunosuppressive effects.
Suarez-Almazor and colleagues added that a lack of clear and consistent society guidelines on the use of biologic DMARDs in patients with RA and cancer may be part of the reason their use has not increased.
“While TNF inhibitors appear to be safe in patients with breast cancer, there is no robust safety data for other cancers or other biologic DMARDs or JAK inhibitors,” Suarez-Almazor told Healio. “With their patients, physicians should carefully weigh the benefits of RA treatment against the uncertainty of a potential risk, as withholding effective RA therapy can have a deleterious impact on quality of life. A personalized management approach is needed considering the patient’s clinical status, cancer characteristics and, most importantly, patient preferences and tolerance to risk.”
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