Rheumatoid arthritis: no higher risk for malignancy with tocilizumab

  • Kim SC & al.
  • Semin Arthritis Rheum
  • 9 Mar 2019

  • International Clinical Digest
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Takeaway

  • A large multidatabase cohort study finds no difference in malignancy risk between tocilizumab vs TNF inhibitors (TNFi) and abatacept in patients with rheumatoid arthritis (RA).

Why this matters

  • Prior studies have been reassuring with respect to TNFi, but less is known about the newer types of biologics.

Study design

  • Retrospective cohort drawing on data from 3 US insurance claims databases: Medicare (2010-2015), "IMS" PharMetrics Plus (2011-2015), and Truven "MarketScan" (2011-2015).
  • Adults with RA who newly started tocilizumab (n=13,102) or a TNFi (propensity-matched, n=26,727) after failing a different TNFi, abatacept or tofacitinib, were included.
  • Primary outcome was incidence of any malignancy except nonmelanoma skin cancer.
  • Funding: Roche.

Key results

  • Crude incidence rates of malignancy ranged from 8.27/1000 person-years (IMS) to 23.18/1000-years (Medicare) among tocilizumab initiators vs 9.64/1000 person-years (MarketScan) to 21.46/1000 person-years (Medicare) among TNFi initiators.
  • Comparing the 2 groups yielded no difference in malignancy rates (combined HR, 0.98; 95% CI, 0.80-1.19).
  • In a secondary analysis, there was no difference between tocilizumab initiators and abatacept initiators (combined HR, 0.97; 95% CI, 0.74-1.27).

Limitations

  • Potential for residual confounding.
  • Observational design.