Risk of malignancy in rheumatoid arthritis patients initiating biologics: an historical propensity score matched cohort study within the French nationwide healthcare database
Objective To compare the risk of malignancy between patients with rheumatoid arthritis (RA) initiating their first biological disease-modifying antirheumatic drug (bDMARD) and those continuing conventional synthetic DMARDs (csDMARDs).Methods Nine-year historical Propensity Score (PS) matched cohort...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-11-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/8/2/e002139.full |
| _version_ | 1827899101733191680 |
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| author | Bruno Fautrel Xavier Mariette Yann De Rycke Florence Tubach Johann castaneda Raphaele Seror Sandrine Pinto Alexandre Lafourcade |
| author_facet | Bruno Fautrel Xavier Mariette Yann De Rycke Florence Tubach Johann castaneda Raphaele Seror Sandrine Pinto Alexandre Lafourcade |
| author_sort | Bruno Fautrel |
| collection | DOAJ |
| description | Objective To compare the risk of malignancy between patients with rheumatoid arthritis (RA) initiating their first biological disease-modifying antirheumatic drug (bDMARD) and those continuing conventional synthetic DMARDs (csDMARDs).Methods Nine-year historical Propensity Score (PS) matched cohort study within the French national healthcare database (87% of the French population; ~57 million people), including adults RA without malignancy. Exposures started with the first use of any systemic treatment (csDMARDs and/or bDMARDs). Incident users of bDMARDs were matched on a dynamic PS to patients continuing csDMARDs. Their risk of malignancy was compared by Cox model.Results From 1 January 2007 to 31 December 2014, 83 706 patients with RA started their first systemic treatment (63 837 remained on csDMARDs and 19 869 initiated a bDMARD during follow-up). After dynamic PS matching, 19 727 bDMARD initiators were compared with 19 727 RA remaining on csDMARDs. They did not statistically differ in risk of overall malignancies (HR 0.99 (95% CI 0.86 to 1.14)), solid cancer (HR 0.95 (95% CI 0.82 to 1.11)), nor lymphoma (HR 1.35 (95% CI 0.72 to 2.53)). Results were similar when bDMARDs were given as monotherapy or in association with csDMARDs. Analyses restricted to patients starting TNF inhibitor as first bDMARD compared with matched RA remaining on csDMARDs, provided similar results (HR for overall malignancy 1.03 (95% CI 0.88 to 1.21)). Sensitivity analyses, varying carry-over periods (up to 5 years) to define risk periods, provided similar results.Conclusions In this historical cohort study within the French nationwide healthcare database, the risk of overall, solid or haematological malignancies did not significantly differ between patients with RA initiating bDMARD and those continuing csDMARDs. |
| first_indexed | 2024-03-12T23:12:37Z |
| format | Article |
| id | doaj.art-8dda68faa6f0427e943ba73f7a84e4f9 |
| institution | Directory Open Access Journal |
| issn | 2056-5933 |
| language | English |
| last_indexed | 2024-03-12T23:12:37Z |
| publishDate | 2022-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj.art-8dda68faa6f0427e943ba73f7a84e4f92023-07-17T20:00:06ZengBMJ Publishing GroupRMD Open2056-59332022-11-018210.1136/rmdopen-2021-002139Risk of malignancy in rheumatoid arthritis patients initiating biologics: an historical propensity score matched cohort study within the French nationwide healthcare databaseBruno Fautrel0Xavier Mariette1Yann De Rycke2Florence Tubach3Johann castaneda4Raphaele Seror5Sandrine Pinto6Alexandre Lafourcade713 Rheumatology, Pitié-Salpêtrière hospital, AP - HP, Paris, FranceDepartment of Rheumatology, Université Paris-Saclay, INSERM UMR1184 : Center for immunology of viral infections and autoimmune diseases, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Le Kremlin-Bicêtre, FranceDépartement Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, Sorbonne Université, Faculté de médecine Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Paris, Francedelete this affiliaton, Paris, FranceCentre de Pharmacoépidémiologie (Cephepi), AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière, Paris, FranceRheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux universitaires Paris-Sud – Hôpital Bicêtre, Le Kremlin Bicêtre, FranceInstitut Pierre Louis d`epidemiologie, Sorbonne University, INSERM UMR-S 1136, Paris, FranceCentre de Pharmacoépidémiologie (Cephepi), AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière, Paris, FranceObjective To compare the risk of malignancy between patients with rheumatoid arthritis (RA) initiating their first biological disease-modifying antirheumatic drug (bDMARD) and those continuing conventional synthetic DMARDs (csDMARDs).Methods Nine-year historical Propensity Score (PS) matched cohort study within the French national healthcare database (87% of the French population; ~57 million people), including adults RA without malignancy. Exposures started with the first use of any systemic treatment (csDMARDs and/or bDMARDs). Incident users of bDMARDs were matched on a dynamic PS to patients continuing csDMARDs. Their risk of malignancy was compared by Cox model.Results From 1 January 2007 to 31 December 2014, 83 706 patients with RA started their first systemic treatment (63 837 remained on csDMARDs and 19 869 initiated a bDMARD during follow-up). After dynamic PS matching, 19 727 bDMARD initiators were compared with 19 727 RA remaining on csDMARDs. They did not statistically differ in risk of overall malignancies (HR 0.99 (95% CI 0.86 to 1.14)), solid cancer (HR 0.95 (95% CI 0.82 to 1.11)), nor lymphoma (HR 1.35 (95% CI 0.72 to 2.53)). Results were similar when bDMARDs were given as monotherapy or in association with csDMARDs. Analyses restricted to patients starting TNF inhibitor as first bDMARD compared with matched RA remaining on csDMARDs, provided similar results (HR for overall malignancy 1.03 (95% CI 0.88 to 1.21)). Sensitivity analyses, varying carry-over periods (up to 5 years) to define risk periods, provided similar results.Conclusions In this historical cohort study within the French nationwide healthcare database, the risk of overall, solid or haematological malignancies did not significantly differ between patients with RA initiating bDMARD and those continuing csDMARDs.https://rmdopen.bmj.com/content/8/2/e002139.full |
| spellingShingle | Bruno Fautrel Xavier Mariette Yann De Rycke Florence Tubach Johann castaneda Raphaele Seror Sandrine Pinto Alexandre Lafourcade Risk of malignancy in rheumatoid arthritis patients initiating biologics: an historical propensity score matched cohort study within the French nationwide healthcare database RMD Open |
| title | Risk of malignancy in rheumatoid arthritis patients initiating biologics: an historical propensity score matched cohort study within the French nationwide healthcare database |
| title_full | Risk of malignancy in rheumatoid arthritis patients initiating biologics: an historical propensity score matched cohort study within the French nationwide healthcare database |
| title_fullStr | Risk of malignancy in rheumatoid arthritis patients initiating biologics: an historical propensity score matched cohort study within the French nationwide healthcare database |
| title_full_unstemmed | Risk of malignancy in rheumatoid arthritis patients initiating biologics: an historical propensity score matched cohort study within the French nationwide healthcare database |
| title_short | Risk of malignancy in rheumatoid arthritis patients initiating biologics: an historical propensity score matched cohort study within the French nationwide healthcare database |
| title_sort | risk of malignancy in rheumatoid arthritis patients initiating biologics an historical propensity score matched cohort study within the french nationwide healthcare database |
| url | https://rmdopen.bmj.com/content/8/2/e002139.full |
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