Classic DMARD s, biologic drugs and cancer risk
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1 Classic DMARD s, biologic drugs and cancer risk Prof. Dr. António M. F. Araújo Head of the Service of Medical Oncology Centro Hospitalar do Porto Instituto de Ciências Biomédicas de Abel Salazar
2 Disclosure slide I provided consultations or attended advisory boards for Astra-Zeneca, Eli Lilly Oncology, F. Hoffman-La Roche Ltd, Merck, Astellas and Pfizer, for which I received appropriate honoraria.
3 DMARD s Disease-Modifying Anti-Rheumatic Drugs Patients with rheumatoid arthritis (RA) and other chronic inflammatory diseases are often subject to prolonged treatment with immunosuppressive drugs which modify the immunologic pathways involved in the pathogenesis of RA.
4 DMARD s Disease-Modifying Anti-Rheumatic Drugs Tumor necrosis factor alpha (TNFα) is among the cytokines that play a major role in the inflammatory process of rheumatic diseases. Its inhibition leads to substantial improvement in clinical signs and symptoms in a majority of patients. TNFα is able to induce tumor cell apoptosis led it to be named TNF before its role in the inflammatory process was revealed. TNFα or rather its nuclear factor-kappa B pathway acts as an early tumor suppressor. This property led to concerns about a possibly increased risk of malignancies when drugs blocking TNFα will be used for long-term treatment.
5 Anti-TNF antibody therapy in RA and risk of cancer Meta-analysis Bongartz T, et al. JAMA 295: , 2006
6 Anti-TNF antibody therapy in RA and risk of cancer Meta-analysis Bongartz T, et al. JAMA 295: , 2006
7 Anti-TNF antibody therapy in RA and risk of cancer Meta-analysis Bongartz T, et al. JAMA 295: , 2006
8 Anti-TNF antibody therapy in RA and risk of cancer Meta-analysis Bongartz T, et al. JAMA 295: , 2006
9 European countries biologics registers
10 German biologics register RABBIT Strangfeld A, et al. Arthritis Res Ther 12:R5, 2010
11 German biologics register RABBIT Strangfeld A, et al. Arthritis Res Ther 12:R5, 2010
12 German biologics register RABBIT Observed cancers and expected cancer from the general population, standardized by age and sex Strangfeld A, et al. Arthritis Res Ther 12:R5, 2010
13 German biologics register RABBIT Observed cancers and expected cancer from the general population, standardized by age and sex Strangfeld A, et al. Arthritis Res Ther 12:R5, 2010
14 British Society for Rheumatology Biologics Register Anti-TNF & cancer incidence in pts with AR and a prior malignancy Dixon WG, et al. Arthritis Care Res 62: , 2010
15 British Society for Rheumatology Biologics Register Anti-TNF & cancer incidence in pts with AR and a prior malignancy NMSC nonmelanoma skin cancer CIS carcinoma in situ Dixon WG, et al. Arthritis Care Res 62: , 2010
16 British Society for Rheumatology Biologics Register Anti-TNF & cancer incidence in pts with AR and a prior malignancy Baseline characteristics Dixon WG, et al. Arthritis Care Res 62: , 2010
17 British Society for Rheumatology Biologics Register Anti-TNF & cancer incidence in pts with AR and a prior malignancy Cumulative incidence of malignancy and rate of incident cancers IRR incidence rate ratio Dixon WG, et al. Arthritis Care Res 62: , 2010
18 British Society for Rheumatology Biologics Register Anti-TNF & cancer incidence in pts with AR and a prior malignancy Cumulative incidence of malignancy and rate of incident cancers Dixon WG, et al. Arthritis Care Res 62: , 2010
19 British Society for Rheumatology Biologics Register Etanercept & DMARD: long-term safety and survival Morgan CL, et al. Rheumatology 53: , 2014
20 British Society for Rheumatology Biologics Register Etanercept & DMARD: long-term safety and survival Morgan CL, et al. Rheumatology 53: , 2014
21 British Society for Rheumatology Biologics Register Etanercept & DMARD: long-term safety and survival Morgan CL, et al. Rheumatology 53: , 2014
22 British Society for Rheumatology Biologics Register Etanercept & DMARD: long-term safety and survival Morgan CL, et al. Rheumatology 53: , 2014
23 British Society for Rheumatology Biologics Register Etanercept & DMARD: long-term safety and survival Morgan CL, et al. Rheumatology 53: , 2014
24 British Society for Rheumatology Biologics Register Etanercept & DMARD: long-term safety and survival Pts with prior cancer ahr=0.877 (95% CI 0.720, 1.069, P = 0.194) Pts without prior cancer ahr=0.804 (95% CI 0.460, 1.403, P = 0.442) Morgan CL, et al. Rheumatology 53: , 2014
25 EULAR recommendations for management of RA Safety of synthetic and biological DMARDs Ramiro S, et al. Ann Rheum Dis 73: , 2014
26 EULAR recommendations for management of RA Safety of synthetic and biological DMARDs Ramiro S, et al. Ann Rheum Dis 73: , 2014
27 EULAR recommendations for management of RA Safety of synthetic and biological DMARDs Ramiro S, et al. Ann Rheum Dis 73: , 2014
28 EULAR recommendations for management of RA Safety of synthetic and biological DMARDs Ramiro S, et al. Ann Rheum Dis 73: , 2014
29 EULAR recommendations for management of RA Safety of synthetic and biological DMARDs Ramiro S, et al. Ann Rheum Dis 73: , 2014
30 EULAR recommendations for management of RA Safety of synthetic and biological DMARDs Ramiro S, et al. Ann Rheum Dis 73: , 2014
31 Conclusions 1. Many randomised controlled trials have been undertaken providing data on the short-term safety of disease-modifying antirheumatic drugs (DMARDs). 2. A milestone in the management of RA has been the development of registries for the long-term evaluation of the safety and effectiveness of both sdmards and bdmards. - Registries following large cohorts of real-world RA patients provide estimates of risk for several agents. 3. The findings from clinial trials and published literature confirm the safety pattern of sdmards and bdmards for the treatment of RA. 4. Overall, the safety of biologic and non-biologic DMARDs appears to be reasonable, particularly compared with the risks associated with the disease itself.
32
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