Background:With an increasing usage of non-TNFi biologics and tofacitinib, it is crucial to understand the comparative safety of these agents regarding malignancies risk.Objectives:We aim to assess the risk of developing cancer in patients with RA exposed to non- TNF inhibitors (TNFi) biologics or tofacitinib therapy.Methods:Systematical search of PubMed, EMBASE and Cochrane Library plus a hand search of conference proceedings were performed for observational studies that reported cancer incidence in patients with RA treated with biologics or tofacitinib with active comparator of conventional DMARDs (csDMARDs) or TNFi. The pooled relative risk (RR) and 95% confidence interval (CI) were calculated with fix-effects or random-effects model.Results:Of 2,819 identified articles, a total of 10 studies involving over 323,361 patients and 1,179,263 patient-years of follow-up were included. Pooled analysis showed there was no increased risk of developing cancer in general or specific cancer types in RA patients receiving treatment with rituximab (pooled RR 1.13, 95% CI 0.80-1.59), tocilizumab (pooled RR 0.96, 95% CI 0.83-1.11), or tofacitinib (pooled RR 0.97, 95% CI 0.66-1.43), compared with those receiving csDMARDs or TNFi. However, abatacept usage in RA was associated with a slightly increased overall cancer risk (pooled RR 1.13, 95% CI 1.02-1.24) and non-melanoma skin cancer (pooled RR 1.26, 95% CI 1.09-1.45), relative to csDMARDs or TNFi.Conclusion:Compared with csDMARDs or TNFi, there was no increased risk of malignancies among RA patients treated with non-TNFi biologics or tofacitinib, with exception of abatacept associated with slightly increased total cancer and specific caner types. Extended researches are required to confirm the findings in a real-world context.References:[1]Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76:960-977.Figure 1.Relative risk of developing cancer between rituximab and csDMARDs. (A) any cancer; (B) all cancer types excluding NMSC; (C) solid tumors; (D) hematological cancer; (E) NMSC; or (F) melanoma. csDMARDs: conventional synthetic disease-modifying antirheumatic drugs. NMSC: non-melanoma skin cancer.Disclosure of Interests:None declared
THU0196 Systematic review and meta-analysis of malignancies, excluding non-melanoma skin cancer, in patients with rheumatoid arthritis treated with tofacitinib or biologic disease-modifying antirheumatic drugs
