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How do we use biologics in rheumatoid arthritis patients with a history of malignancy? An assessment of treatment patterns using Scandinavian registers
  1. Katerina Chatzidionysiou1,
  2. Bénédicte Delcoigne1,
  3. Thomas Frisell1,
  4. Merete L Hetland2,3,
  5. Bente Glintborg2,3,
  6. lene dreyer4,5,
  7. René Cordtz6,
  8. Kristian Zobbe6,
  9. Dan Nordström7,
  10. Nina Trokovic7,
  11. Kalle Aaltonen8,
  12. Sella Aarrestad Provan9,
  13. Gerdur Grondal10,
  14. Bjorn Gudbjornsson11 and
  15. Johan Askling1
  1. 1Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska Institutet Department of Medicine Solna, Stockholm, Sweden
  2. 2DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark
  3. 3Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  4. 4Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
  5. 5Department of Clinical Medicine, Aalborg Universitet, Aalborg, Denmark
  6. 6Center for Rheumatology and Spine Diseases, Rigshospitalet, Gentofte Hospital, The Parker Institute, Frederiksberg Hospital Parker Institute, Frederiksberg, Denmark
  7. 7Helsinki University and Hospital (ROB-FIN), Departments of Medicine and Rheumatology, Helsinki University Central Hospital, Helsinki, Finland
  8. 8Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
  9. 9Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  10. 10Department of Rheumatology and Centre for Rheumatology Research, National University Hospital of Iceland, Reykjavik, Iceland
  11. 11Centre for Rheumatology Research, University Hospital, and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  1. Correspondence to Katerina Chatzidionysiou; aikaterini.chatzidionysiou{at}

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Immune competence is of importance for the occurrence and outcome of malignancies, as exemplified by the effects of immune checkpoint inhibitors in the treatment of malignancies.1 An increased risk for malignancies has been one of the main concerns since the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) for the treatment of chronic inflammatory arthritis. Most treatment guidelines have therefore issued caution against using bDMARDs (tumour necrosis factor inhibitors (TNFi) in particular) in patients with a history of cancer within 5–10 years. So far, most (though not all) studies of cancer incidence following treatment with TNFi and other bDMARDs, and of recurrence of pre-treatment cancers following treatment with TNFi, have been reassuring.2–9 The 2015 ACR recommendations for treatment of rheumatoid arthritis (RA) recommend that patients with a history of previous solid organ malignancy should be treated as patients without this condition,10 though acknowledging the low level of evidence, whereas previous recommendations suggested rituximab.11 Similarly, there is no consensus regarding the time period from cancer diagnosis until the safe initiation of a bDMARD. Thus, scientific evidence supporting clinical decision-making in this context is scarce.

The aim of the present study was to assess the relative use of different bDMARDs in patients with RA and history of cancer. We used real-life data from the DANBIO (Denmark), ROB-FIN (Finland), NOR-DMARD (Norway) and ARTIS (Sweden) bDMARD registers. We identified patients with RA who initiated any bDMARD between year 2010–2017, regardless of type or number of prior bDMARDs. We identified patients with a clinical rheumatologist-assigned diagnosis of RA regardless of fulfilment of …

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