For Previous Cancer Patients, Biologics Don’t Increase Risk
I know from personal experience how difficult it can be to live with rheumatoid arthritis (RA). From facing excruciating joint pain to fighting against chronic fatigue to dealing with the emotional and social impact, RA can truly influence every aspect of a person’s life. So my heart always goes out to individuals who have had to face a diagnosis of cancer in addition to a diagnosis of RA.
Most of us have been told how important it is to treat RA early and aggressively. Many rheumatologists claim that treating RA this way can help stop the disease in it’s tracks, leading to significantly better outcomes for the patient. However, early and aggressive RA treatment often requires the use of a biologic medication – and this can create a bit of a conundrum for patients who have been previously diagnosed with cancer.
The role of biologics
Biologic medications function by purposefully suppressing the immune system, so the immune system won’t mistakenly attack healthy joints. However, this immune suppression has led some doctors to be concerned that biologic medications could potentially increase the risk of malignancy in patients with a previous history of cancer. In addition, the list of potential risks and side effects for most biologics generally includes a slightly increased risk of developing certain types of cancer.
The suppressed immune system and possible increased risk of cancer has led some doctors and patients to be reluctant to consider biologics, especially in situations where the patient has a previous history of cancer. Unfortunately, this can leave patients with RA dealing with insufficient treatment options – and forgoing early and aggressive treatment may lead to difficulty getting their RA under control, as well as additional permanent joint damage in the future.
But I have good news!
For RA patients with a previous history of cancer, new research has demonstrated that treatment with biologic medications does not increase the risk of a second malignancy. These findings were recently presented at the 2017 American College of Rheumatology Annual Meeting in San Diego.
A team of researchers in Denmark set out to determine whether there was a real cause for concern in situations where RA patients with a previous cancer diagnosis required treatment with a biologic medication. Patients meeting the criteria (i.e. those who had been diagnosed with RA and had a previous cancer diagnosis) were selected from a national medical records database in Denmark from the period of 2000 to 2011. Of these patients, 190 had received biologic medications only before their cancer diagnosis, 220 had received biologics after their cancer diagnosis, and 1,176 had never received biologics at all.
The researchers analyzed all the data to determine if the use of biologic medications to treat RA increased the risk of a second malignancy. This risk is called the “hazard ratio,” which is a comparison between the probability of events. In this case, the comparison was between the rate of second malignancy in patients who used biologic medications to treat their RA and the rate of second malignancy in patients who did not use biologics to treat their RA.
Dr. Lene Dryer, Associate Professor of Rheumatology at the University of Copenhagen and lead researcher on this study, summarized the results in a press release. “It is reassuring that these results indicate no increased risk of a second malignancy in RA patients with a past cancer who used biologic therapy,” she said. “Our data does provide some reassurance that biologics don’t pose an immediate danger in patients with a history of cancer.”
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?