Malignancies and Biologic Therapy in Rheumatoid Arthritis: A Retrospective Study

Objectives: To observe the incidence of malignancies in the group of patients diagnosed with rheumatoid arthritis and treated with biologic therapy. Methods: A retrospective study on 157 subjects diagnosed with rheumatoid arthritis (RA) who underwent biologic treatment with Infliximab (IFX), Adalimumab (ADA), Etanercept (ETA) or Rituximab (RTX) was conducted in Rheumatology Clinic from Cluj-Napoca, between June 2012 and August 2012. Results: 44% of patients were treated with IFX, 24% with ETA, 10% with ADA and 22% with RTX. Seven malignancies (4.45%) were identified; 2 cases were with basal cell carcinoma of the skin (IFX, after a median duration of 84 months from the start of this therapy). These two malignancies were surgically removed and there was no need to stop IFX. A Bowen tumor was diagnosed after 8 months from the beginning of ETA treatment. Two cases of myeloproliferative disorder were identified after a median of 36 months time from the start of IFX. 1 of these 2 subjects underwent a specific therapy. 2 other female patients were diagnosed with ovarian carcinoma and cholangyocarcinoma respectively, during treatment with RTX (6 months on average after start). These patients have been previously treated with IFX or ETA that were discontinued due to lack of efficacy. Tumors were surgically removed and patients underwent chemotherapy. RTX was stopped. Conclusions: The most frequent malignancies in our sample were cutaneous carcinomas and myeloproliferative syndromes; they were not diagnosed in the first year. The treatment duration with different biologic were not related with the occurrence of malignancies.