Seoyoung C Kim1, Ajinkya Pawar2, Rishi J Desai2, Daniel H Solomon3, Sara Gale4, Min Bao4, Khaled Sarsour4, Sebastian Schneeweiss2. 1. Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston MA 02120, USA; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: sykim@bwh.harvard.edu. 2. Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston MA 02120, USA. 3. Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston MA 02120, USA; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA. 4. Genentech, South San Francisco, CA, USA.
Abstract
OBJECTIVES: To examine the rate of incident malignancies excluding non-melanoma skin cancer (NMSC) in patients with rheumatoid arthritis (RA) newly treated with tocilizumab versus other biologic drugs. METHODS: We conducted a cohort study using data from 3 U.S. insurance claims databases - Medicare (2010-2015), 'IMS' PharMetrics Plus (2011-2015) and Truven 'MarketScan' (2011-2015). Adults with RA who newly started tocilizumab or a TNF inhibitor (TNFi) after failing a different TNFi, abatacept or tofacitinib were included. The primary outcome was development of any malignancies excluding NMSC. For confounding control, tocilizumab starters were propensity score (PS)-matched to TNFi starters with a variable ratio of 1:3 within each database. Hazard ratios (HR) from the 3 PS-matched cohorts were combined by an inverse variance-weighted, fixed-effects model. We conducted a secondary analysis where we compared tocilizumab initiators with abatacept initiators. RESULTS: We included 13,102 tocilizumab initiators PS-matched to 26,727 TNFi initiators in all three databases. The incidence rate of malignancies per 1,000 person-years ranged from 8.27 (IMS) to 23.18 (Medicare) in the tocilizumab group and from 9.64 (MarketScan) to 21.46 (Medicare) in the TNFi group. The risk of incident malignancies was similar between tocilizumab and TNFi initiators across all three databases, with a combined HR of 0.98 (95%CI 0.80-1.19) in tocilizumab versus TNFi. The secondary analysis comparing tocilizumab versus abatacept showed similar results (combined HR 0.97, 95%CI 0.74-1.27). CONCLUSIONS: This large multi-database cohort study found no difference in the risk of malignancies excluding NMSC in RA patients who newly started tocilizumab compared with TNFi or abatacept.
OBJECTIVES: To examine the rate of incident malignancies excluding non-melanoma skin cancer (NMSC) in patients with rheumatoid arthritis (RA) newly treated with tocilizumab versus other biologic drugs. METHODS: We conducted a cohort study using data from 3 U.S. insurance claims databases - Medicare (2010-2015), 'IMS' PharMetrics Plus (2011-2015) and Truven 'MarketScan' (2011-2015). Adults with RA who newly started tocilizumab or a TNF inhibitor (TNFi) after failing a different TNFi, abatacept or tofacitinib were included. The primary outcome was development of any malignancies excluding NMSC. For confounding control, tocilizumab starters were propensity score (PS)-matched to TNFi starters with a variable ratio of 1:3 within each database. Hazard ratios (HR) from the 3 PS-matched cohorts were combined by an inverse variance-weighted, fixed-effects model. We conducted a secondary analysis where we compared tocilizumab initiators with abatacept initiators. RESULTS: We included 13,102 tocilizumab initiators PS-matched to 26,727 TNFi initiators in all three databases. The incidence rate of malignancies per 1,000 person-years ranged from 8.27 (IMS) to 23.18 (Medicare) in the tocilizumab group and from 9.64 (MarketScan) to 21.46 (Medicare) in the TNFi group. The risk of incident malignancies was similar between tocilizumab and TNFi initiators across all three databases, with a combined HR of 0.98 (95%CI 0.80-1.19) in tocilizumab versus TNFi. The secondary analysis comparing tocilizumab versus abatacept showed similar results (combined HR 0.97, 95%CI 0.74-1.27). CONCLUSIONS: This large multi-database cohort study found no difference in the risk of malignancies excluding NMSC in RApatients who newly started tocilizumab compared with TNFi or abatacept.
Authors: Teresa A Simon; Maarten Boers; Marc Hochberg; Nicole Baker; Mary L Skovron; Nitesh Ray; Sanket Singhal; Samy Suissa; Andres Gomez-Caminero Journal: Arthritis Res Ther Date: 2019-11-08 Impact factor: 5.156
Authors: Peter C Taylor; Tsutomu Takeuchi; Gerd R Burmester; Patrick Durez; Josef S Smolen; Walter Deberdt; Maher Issa; Jorge Ross Terres; Natalia Bello; Kevin L Winthrop Journal: Ann Rheum Dis Date: 2021-10-27 Impact factor: 19.103
Authors: Thomas Bieber; Eugen Feist; Alan D Irvine; Masayoshi Harigai; Ewa Haladyj; Susan Ball; Walter Deberdt; Maher Issa; Susanne Grond; Peter C Taylor Journal: Adv Ther Date: 2022-09-05 Impact factor: 4.070
Authors: Kastriot Kastrati; Daniel Aletaha; Gerd R Burmester; Eva Chwala; Christian Dejaco; Maxime Dougados; Iain B McInnes; Angelo Ravelli; Naveed Sattar; Tanja A Stamm; Tsutomu Takeuchi; Michael Trauner; Desirée van der Heijde; Marieke J H Voshaar; Kevin Winthrop; Josef S Smolen; Andreas Kerschbaumer Journal: RMD Open Date: 2022-09