Therapy with Biologic Agents After Diagnosis of Solid Malignancies: Results from the Corrona Registry
Therapy with Biologic Agents After Diagnosis of Solid Malignancies: Results from the Corrona Registry
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DOI：
10.3899/jrheum.171457
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发表时间：
2019-11-01
影响因子：
3.9
通讯作者：
Accortt, Neil A.
中科院分区：
文献类型：
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作者：
Pappas, Dimitrios A.;Rebello, Sabrina;Accortt, Neil A.
目标。指南建议，类风湿性关节炎(RA)患者以前治疗过的实体恶性肿瘤患者可以作为没有此类病史的患者进行治疗。这一建议是基于有限的证据，风湿科医生和患者在癌症诊断后经常对开始或继续生物治疗犹豫不决。这项研究的目的是描述真实世界中的RA患者在恶性肿瘤诊断后的生物学应用。在CORRONA登记登记的RA患者被诊断为实体恶性肿瘤，并在诊断后12个月内至少进行一次随访，纳入本分析。估计在确诊后继续或开始使用生物/靶向合成抗风湿药物(bDMARD/tsDMARD)的患者的比例。用Kaplan-Meier方法计算诊断后开始bDMARD/tsDMARD的中位时间，用寿命表法估计在6个月时间间隔内开始生物治疗的比例。有880名患者符合纳入标准，诊断后总随访时间为2585人年。其中367例(41.7%)在癌变前12个月内接受bDMARD/tsDMARD治疗，其中270例(30.7%)在确诊后首次就诊时服用bDMARD/tsDMARD。44名患者(5%)在36个月内更换了生物制剂，另外90名患者(10.2%)开始了生物制剂。在随访期间，大多数bDMARD/tsDMARD启动是一种肿瘤坏死因子抑制物(TNFi；53.5%)。在现实生活中，近三分之一被诊断为癌症的类风湿关节炎患者在被诊断为癌症后立即接受系统治疗，相当大比例的恶性肿瘤幸存者在3年内开始生物治疗。大多数bDMARD/tsDMARD在恶性肿瘤诊断后发起的是TNFi。
Objective. Guidelines suggest that rheumatoid arthritis (RA) patients with previously treated solid malignancy may be treated as patients without such history. The recommendation is based on limited evidence, and rheumatologists and patients are frequently hesitant to start or continue biologic therapy after a cancer diagnosis. The objective of this study was to describe biologic use in real-world patients with RA following a malignancy diagnosis.Methods. RA patients enrolled in the Corrona registry and diagnosed with solid malignancy with at least 1 followup visit within 12 months after diagnosis were included in this analysis. The proportion of patients continuing or initiating biological/targeted synthetic disease-modifying antirheumatic drug (bDMARD/tsDMARD) after diagnosis was estimated. Median time to initiation of bDMARD/tsDMARD after diagnosis was calculated using the Kaplan-Meier method and the proportion initiating biologic treatment in 6-month time intervals was estimated using the life-table method.Results. There were 880 patients who met inclusion criteria with 2585 person-years total followup time postdiagnosis. Of those, 367 (41.7%) were treated with bDMARD/tsDMARD within 12 months preceding malignancy, of whom 270 (30.7%) were taking such agents at first postdiagnosis visit. Forty-four (5%) switched biologic agents within 36 months and an additional 90 patients (10.2%) started a biologic. The majority of bDMARD/tsDMARD initiations during followup was a tumor necrosis factor inhibitor (TNFi; 53.5%).Conclusion. In real-world practice, nearly one-third of RA patients with a cancer diagnosis were treated with systemic therapy in the immediate visit after malignancy diagnosis and a considerable percentage of malignancy survivors initiated biologic therapy within 3 years. The majority of bDMARD/tsDMARD initiations post-malignancy diagnosis was a TNFi.