PO:01:006 | Increased risk of cancer recurrence or mortality associated with DMARDs?
Laura Scagnellato1, Giacomo Cozzi1, Mariagrazia Lorenzin1, Mariangela Salvato1, Alessandro Giollo1, Bernd Raffeiner1, Antonia Calligaro1, Teresa Del Ross1, Sara Bindoli1, Margherita Zen1, Paolo Sfriso1, Andrea Doria1, Roberta Ramonda1. | 1UOC Reumatologia, Dipartimento di Medicina dei Sistemi DIMED, Ospedale Università di Padova, Padova, Italy.
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Background. Our study endeavoured to investigate the real-life use of immunosuppressants after cancer diagnosis in patients with spondyloarthritis (SpA) and rheumatoid arthritis (RA) and the associated risk of cancer recurrence or mortality.
Methods. We retrospectively enrolled all patients with invasive cancer and SpA, psoriatic arthritis (PsA) or RA referred to two Italian centres between 2015 and 2024. Invasive cancer was defined as any solid or haematologic cancer with histological characteristics of invasiveness. Cancer recurrence or progression were recorded consulting oncologic reports. After correction for the immortal bias, we performed a survival analysis using a model with cumulative incidence for competing events and subdistribution hazard ratios (SHR) estimates.
Results. Overall, we included 120 patients with SpA/RA (39 SpA, 37 PsA, 44 RA) who developed invasive cancer. Most patients were undergoing csDMARDs and bDMARDs treatment before cancer diagnosis, or initiated immunosuppressants (including TNF, IL-6, IL-17, IL-23, JAK inhibitors and CTLA4a) after cancer diagnosis. 24 (20%) patients experienced a cancer relapse or progression, of whom 7 subsequently died. 2 other patients died of other causes during follow-up. Treatment with bDMARDs/JAKi before and after cancer did not appear to significantly increase the risk of recurrence and/or death (SHR p-value = 0.26; SHR p-value= 0.78), after correction for treatment before cancer diagnosis. RA was significantly associated with a higher risk of recurrence (SHR p-value <0.05). Early introduction of bDMARDs, particularly in RA, increased the risk of recurrence/death (HR p-value <0.05).
Conclusion. The management of patients with SpA and RA who develop cancer may require initiation of immunosuppressants before the 5-year safety cutoff in the most severe cases. Among biologics, IL6i, IL17i and IL23i have proven to be the safest classes for use in patients with rheumatic diseases who develop cancer (1,2). 1. Atzeni F, Carletto A, Foti R, et al. Incidence of cancer in patients with spondyloarthritis treated with anti-TNF drugs. Joint Bone Spine. 2018;85(4):455-459. doi:10.1016/j.jbspin.2017.08.003 2. Scagnellato L, Collesei A, Doria A, et al. Comorbidities in the Spondyloarthritis GISEA Cohort: an average treatment effect analysis on patients treated with bDMARDs. Clin Exp Rheumatol. Published online February 8, 2023. doi:10.55563/clinexprheumatol/q38lu0 
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