Abstract
Objectives: To investigate whether there is an elevated neoplasm risk in patients with rheumatic diseases treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).Methods: A population-based nested case–control study was performed by retrieving all patients newly diagnosed with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriatic arthritis (PsA) or psoriasis vulgaris (PsO) from the 2000 Longitudinal Health Insurance Database (LHID 2000) in Taiwan. Two hundred and sixty-one patients with neoplasm from 1997 to 2013 were enrolled in this study, and controls were matched in a 1:1 ratio with age, sex, and year of enrollment. Composition of demographic indices, comorbidities, medication usage, and differences in days of prescription of different medications between neoplasm and neoplasm-free (control) groups were compared.Results: Between the control and neoplasm groups, no differences in ratio were observed in the usage of hydroxychloroquine (50.96 vs. 49.04%, p = 0.6616), methotrexate (26.82 vs. 27.59%, p = 0.8441), azathioprine (3.45 vs. 3.07%, p = 0.8052), and cyclophosphamide (1.15 vs. 2.30%, p = 0.3131) from enrollment to index date. Medications within 3 years before the index date in patients that had ≥3 months of comparable duration also showed no difference (hydroxychloroquine: 33.06 vs. 30.25%, p = 0.6404; methotrexate: 20.66 vs. 25.21%, p = 0.4018; azathioprine: 2.48 vs. 2.52%, p = 0.9835; cyclophosphamide: 0.83 vs. 0.84%, p = 0.9906). We also made a subgroup analysis focusing on RA and SLE patients; no difference between control and neoplasm group in both the ratio of usage and days of prescription of hydroxychloroquine, methotrexate, azathioprine, and cyclophosphamide was observed.Conclusion: Neoplasm risk in patients with rheumatic diseases has no correlation with csDMARD usage.
Highlights
Disease-modifying antirheumatic drugs (DMARDs) are a group of drugs defined by their effects of slowing down disease progression, which can be divided into biologic DMARDs and targeted synthetic DMARDs and conventional synthetic DMARDs
We made a subgroup analysis focusing on rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients; no difference between control and neoplasm group in both the ratio of usage and days of prescription of hydroxychloroquine, methotrexate, azathioprine, and cyclophosphamide was observed
Neoplasm risk in patients with rheumatic diseases has no correlation with csDMARD usage
Summary
Disease-modifying antirheumatic drugs (DMARDs) are a group of drugs defined by their effects of slowing down disease progression, which can be divided into biologic DMARDs and targeted synthetic DMARDs (tsDMARDs) and conventional synthetic DMARDs (csDMARDs). Hydroxychloroquine (HCQ), methotrexate (MTX), azathioprine (AZA), and cyclophosphamide (CTX) are commonly prescribed csDMARDs, for systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and psoriasis (PsO) or psoriatic arthritis (PsA) patients, of which the usages have been suggested in treatment guidelines of corresponding diseases [1,2,3]. All these csDMARDs function as non-targeted immunosuppressive/modulatory agents, and some of the agents described above work via the interfering cell cycle [4,5,6]. In consideration of the relative long-term usage of csDMARDs of patients with rheumatic diseases (RD), and the relationship of predisposition of malignancy to races and regions, based on a population-based database of health insurance research in Taiwan, we aimed here to compare the medication differences between RD patients without malignancy and RD patients with malignancy after exposure to csDMARDs targeting East Asians
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