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

Abstract

There is no recommendation for the use of disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA) who developed cancer. We examined changes in the DMARDs prescription patterns associated with cancer diagnosis in RA patients. Methods: We reviewed the medical records of 2,161 RA patients who visited rheumatology clinic between January 2008 and February 2017 and found 40 patients who developed cancer during RA treatment. In these patients, we examined DMARDs prescription patterns before and right after cancer diagnosis and at recent outpatient clinic visits. Results: Before cancer diagnosis, methotrexate (MTX)-combined conventional synthetic DMARDs (csDMARDs) were most commonly prescribed (22, 55.0%) and biological DMARDs (biologics) in nine patients (22.5%). For cancer treatment, 19 patients received chemotherapy (including adjuvant chemotherapy) and 21 patients had surgery only. Right after cancer diagnosis, changes in the DMARDs prescription patterns were similar in discontinuation (13, 32.5%), switching (14, 35.0%), and maintenance (13, 32.5%). DMARDs were discontinued more frequently in the chemotherapy group (9/19, 47.4%) than the surgery only group (4/2, 19.0%) (p<0.05). Among the 13 patients who discontinued DMARDs, nine (69.2%) resumed DMARDs after a median of 5.5 months (interquartile range [IQR] 2.9, 18.3) due to arthritis flare. At a median of 4.6 years (IQR 3.3, 6.7) after cancer diagnosis, 25 patients were evaluated at recent outpatient clinic visits. Four patients received no DMARD, three MTX monotherapies, 11 csD-MARDs combination therapies, and seven biologics. Conclusion: A significant number of RA patients who developed cancer during RA treatment were still receiving DMARDs including biologics after cancer diagnosis.

Correlation Of Lipid Profile and Das28 Score of Early Rheumatoid Arthritis Patients on Conventional Synthetic Dmards

“…Patients with rheumatoid arthritis (RA), a chronic and progressive autoimmune disease, face a significantly increased risk of cardiovascular disease (CVD), estimated to be 2-to 3-fold higher than in the general population (1,2). This elevated risk is largely attributed to factors such as chronic inflammation inherent to the disease, reduced physical activity, increased adiposity, insulin resistance, and altered lipid profiles (3).…”

“…Conventional synthetic disease-modifying antirheumatic drugs (DMARDs) play a crucial role in the treatment of inflammatory arthritides, including RA. They are also used in managing other connective tissue diseases and some cancers (1)(2)(3) . The use of DMARDs in RA aims not only to manage joint symptoms but also to address systemic manifestations of the disease.…”

Rheumatoid Arthritis and Malignancy: What Should We Do With DMARDs?

“…Although malignancy is a frequent cause of morbidity and mortality, information on the management of RA in patients with malignancy is scarce. In this respect, the study that Joo et al [ 2 ] published in the previous issue of Journal of Rheumatic Diseases provides valuable information on current practice among such patients, suggesting the unmet clinical needs of this population.…”

“…In the study by Joo et al [ 2 ], a substantial number of patients continued DMARDs (switching regimen in 35%, maintenance in 32.5%) immediately after a diagnosis of malignancy. Moreover, a large proportion (69.2%) of patients who discontinued DMARDs eventually resumed drugs within a few months after diagnosis [ 2 ]. This illustrates that a significant number of patients still need DMARDs while being treated for malignancy due to persistence or aggravation of RA.…”

“…In the study by Joo et al [2], a substantial number of patients continued DMARDs (switching regimen in 35%, maintenance in 32.5%) immediately after a diagnosis of malignancy. Moreover, a large proportion (69.2%) of patients who discontinued DMARDs eventually resumed drugs within a few months after diagnosis [2].…”