No Difference in Malignancy Risk With Tocilizumab vs TNFis, Abatacept in RA

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Researchers found that there was no difference in the incidence of malignancy in patients with rheumatoid arthritis who switched from biologic disease-modifying antirheumatic drugs or tofacitinib to tocilizumab compared with patients who used abatacept or a different tumor necrosis factor inhibitor, except in instances of nonmelanoma skin cancer.

No differences in the risk for incident malignancies, with the exception of nonmelanoma skin cancer, were found in patients with rheumatoid arthritis (RA) who newly initiated tocilizumab vs other biologics, according to study results published in Seminars in Arthritis and Rheumatism.

Researchers conducted a cohort study that included data from 3 US insurance claim databases. The analysis consisted of patients with RA who newly initiated tocilizumab or a tumor necrosis factor inhibitor (TNFi) following non-response to treatment with an alternative TNFi, tofacitinib, or abatacept. The primary outcome measured was the occurrence of any malignancy, with the exception of nonmelanoma skin cancer. Patients receiving tocilizumab (n=13,102) were propensity score-matched to patients who received a TNFi (n=26,727) in each respective database.

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After analysis, the researchers found that the risk for any new malignancies was comparable in TNFi initiators and tocilizumab across all databases (combined hazard ratio [HR], 0.98; 95% CI, 0.80-1.19). In addition, the results from a secondary analysis showed similar findings when comparing tocilizumab and abatacept (combined HR, 0.97; 95% CI, 0.74-1.27).

One key study limitation was the effects of residual confounding.

“This large multi-database cohort study found no difference in the risk of malignancies excluding nonmelanoma skin cancer in RA patients who newly started tocilizumab compared with TNFi or abatacept,” the researchers wrote.


Kim SC, Pawar A, Desai RJ, et al. Risk of malignancy associated with use of tocilizumab versus other biologics in patients with rheumatoid arthritis: A multi-database cohort study [published online March 9, 2019]. Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2019.03.002