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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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