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Title: A Practical Approach to the Use of Conventional Synthetic, Biologic and Targeted Synthetic Disease Modifying Anti-Rheumatic Drugs for the Treatment of Inflammatory Arthritis in Patients with a History of Malignancy.
Austin Authors: Wong, Peter K K;Bagga, Hanish;Barrett, Claire;Chong, Geoffrey ;Hanrahan, Patrick;Kodali, Teja;Marabani, Mona;Prince, H Miles;Riordan, John;Swarbrick, Phillip;White, Ray;Young, Laurel
Affiliation: Redcliffe Hospital, Redcliffe, Queensland, Australia
Campsie Rheumatology Clinic and Canterbury Hospital, Sydney, New South Wales, Australia
Molecular Oncology and Cancer Immunology, Epworth Healthcare, Richmond, Victoria, Australia
Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
Illawarra Rheumatology and University of Wollongong Graduate School of Medicine, Wollongong, New South Wales, Australia
Private Dermatology Practice, Burswood, Western Australia, Australia
Private Rheumatology Practice, Campbelltown, New South Wales, Australia
Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia
University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia
Redcliffe and Northside Rheumatology, Redcliffe, Queensland, Australia
Faculty of Medicine, University of Queensland, St Lucia, Australia
Private Rheumatology practice, South Perth, Western Australia, Australia
School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 1-Sep-2018
Date: 2018-09-01
Publication information: Current rheumatology reports 2018; 20(10): 64
Abstract: Conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) have been used in the treatment of inflammatory arthritis (IA) for many years. More recently, biologic (bDMARDs) and targeted synthetic (tsDMARDs) DMARDs have further improved treatment. Due to increased patient longevity and effective oncology treatment, rheumatologists often encounter patients with IA and previous malignancy. The immunosuppressive effect of DMARDs causes concern regarding impaired tumour surveillance with a potential increased risk of malignancy. We reviewed the literature regarding the risk of malignancy in patients on cs-/b-/tsDMARDS and sought to provide practical advice regarding use of these drugs in patients with previous malignancy. Data from randomised controlled trials is limited as patients with pre-existing malignancy are often excluded. Reassuringly, an increasing range of "real world" data from various national b/tsDMARD registries has not provided a convincing signal that these drugs increase tumour recurrence. Nevertheless, awareness of, and adherence to, national screening guidelines for malignancy is important. Given the improvement in quality of life achieved with these novel and well-tolerated therapeutic agents, the benefit/risk profile remains overwhelmingly favourable in most patients.
DOI: 10.1007/s11926-018-0774-9
Journal: Current rheumatology reports
PubMed URL: 30173305
Type: Journal Article
Subjects: Biologics
Disease modifying anti-rheumatic drugs
Appears in Collections:Journal articles

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