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Current guidelines regarding the use of biologics in patients who have previously had a malignancy are based more on opinion than evidence.
The ARTIS registry previously showed that women with a prior breast cancer who went on to receive a TNF inhibitor (TNFi) were not at great risk of breast cancer recurrence (http://buff.ly/2cfkrsv). They have also showed that cancers occurring after initiation of TNFi therapy do not have worse outcomes or reduced survival compared to cancer patients not exposed to TNFi (http://www.ncbi.nlm.nih.gov/pubmed/21305513).
The British Biologics Registry (BSRBR) examined 425 patients with a prior malignancy and assessed rates of recurrent malignancy in patients treaed with either a TNFi, rituximab (RTX) or synthetic DMARDs (sDMARD).
Roughly one-quarter developed a new malignancy. The incident malignancy rates and adjusted hazard ratios (HR) were:
Recurrent Malignancy Rate/1000OPY
|(95% CI)||(0.35, 0.86)||(0.10, 1.80||-|
The 17.0% of patients in the sDMARDs cohort had a recurrence of the same cancer in comparison with the 12.8% and the 4.3% in the TNFi and RTX cohorts.
These findings suggest that RA patients with a prior malignancy may be safetly treated with either a TNFi or RTX.