Systematic Review of Recommendations on the Use of Disease‐Modifying Antirheumatic Drugs in Patients With Rheumatoid Arthritis and Cancer

Abstract

Objective To evaluate consensus recommendations regarding management of rheumatoid arthritis (RA) in patients with cancer. Methods We searched electronic databases, guideline registries, and relevant web sites for cancer‐specific recommendations on RA management. Reviewers independently selected and appraised the recommendations according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. We identified similarities and discrepancies among recommendations. Results Of 4,077 unique citations, 39 recommendations were identified, of which half described their consensus process. Average scores for the AGREE II domains ranged from 33% to 87%. Cancer risk in RA was addressed in 79% of recommendations, with acknowledgement of increased overall cancer risk. Recommendations did not agree on the safety of using disease‐modifying antirheumatic drugs (DMARDs) in RA patients with cancer, except for the contraindication of tumor necrosis factor inhibitors in patients at risk for lymphoma. Most recommendations agreed that RA treatment should be stopped and re‐evaluated with a new diagnosis of cancer. Recommendations for patients with a history of cancer differed depending on the drug, cancer type, and time since cancer diagnosis. Few recommendations addressed all issues. Conclusion Recommendations for the treatment of RA in patients with cancer often fail to meet expected methodologic criteria. There was agreement on the need for caution when prescribing DMARDs to these patients. However, several areas continue to lack consensus, and given the paucity of evidence, there is an urgent need for research and expert opinion to guide and standardize the management of RA in patients with cancer.

Use of Disease-modifying Antirheumatic Drugs After Cancer Diagnosis in Rheumatoid Arthritis Patients

“…Although malignancies are common in RA patients, a guideline for the treatment of RA patients with cancer has not yet been established [4][5][6][7].…”

“…Mamtani et al [21] reported that starting anti-TNF therapy 1 year after primary breast cancer surgery did not significantly increase the risk of breast cancer recurrence. Pundole et al [22] [4,6,7]. In addition, it has been known that newer cancer immunotherapies can stimulate the immune system and cause autoimmune manifestations including flares of RA disease activity.…”

Identifying chemicals linked to lung cancer: Integrating genome-wide association studies with a chemical-gene interaction network

“…Whereas thiopurines and anti-TNFα preparations were reported to increase the risk of skin cancer and lymphoma (39). Notably, there is now a consensus over the contraindication of tumor necrosis factor inhibitors in patients at risk for lymphoma (40). Due to the wide variety and complex mechanism of DMARDs, the relationship between DMARDs and LUAD needs further study.…”

Rheumatologische medikamentöse Therapie bei Malignomanamnese

“…Es existieren viele nationale und internationale Leitlinien zur Therapie der rheumatoiden Arthritis, die sich unterschiedlich detailliert mit dem Thema Malignomanamnese befassen [10]. Die klarsten Empfehlungen hierzu wurden 2012 und 2015 vom American College of Rheumatology formuliert [11,12].…”