Volume 76, Issue 6 p. 850-859
Original Article

Utilization of Biologic Disease-Modifying Antirheumatic Therapy in Patients With Rheumatoid Arthritis and Recently Diagnosed Breast Cancer

Juan I. Ruiz

Juan I. Ruiz

Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Xiudong Lei

Xiudong Lei

Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Chi-Fang Wu

Chi-Fang Wu

Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Hui Zhao

Hui Zhao

Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Sharon H. Giordano

Sharon H. Giordano

Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Suja S. Rajan

Suja S. Rajan

Department of Management, Policy and Community Heath, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas

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Maria E. Suarez-Almazor

Corresponding Author

Maria E. Suarez-Almazor

Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas

Address correspondence via email to Maria E. Suarez-Almazor, MD, PhD, at [email protected].

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First published: 25 January 2024

The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors. The study sponsor did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH (grant R01-AR-078484), The University of Texas MD Anderson's Cancer Center Support grant from National Cancer Institute, NIH (grant P30-CA-016672). Dr Giordano's work was supported by Komen (grants SAC 150061 and CPRIT RP160674). The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention's National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute.

Additional supplementary information cited in this article can be found online in the Supporting Information section (http://onlinelibrary.wiley.com/doi/10.1002/acr.25306).

Author disclosures and graphical abstract are available at https://onlinelibrary.wiley.com/doi/10.1002/acr.25306.

Abstract

Objective

Biologic disease-modifying antirheumatic drugs (bDMARDs) are immunosuppressants, and there have been concerns that they might impact tumor immunity in patients with cancer with rheumatoid arthritis (RA). The purpose of this study was to describe the utilization trends of bDMARD in patients with RA after breast cancer (BC) diagnosis.

Methods

We performed a retrospective cohort study of adults with RA and BC (2008 onward) from Optum's de-identified Clinformatics® Data Mart Database (CDM); the Surveillance, Epidemiology, and End Results Program (SEER) Medicare; and the Texas Cancer Registry (TCR) Medicare databases. We evaluated bDMARD utilization trends during the first three years after BC. We conducted multivariable logistic regression to evaluate the association of utilization with patient characteristics.

Results

A total 1,412 patients were identified in CDM and 1,439 patients in SEER/TCR-Medicare. During the three months before BC diagnosis, 28.2% (CDM) and 26.9% (SEER/TCR-Medicare) patients had received bDMARDs. Within the first three years after diagnosis, 24.1% (CDM) and 26.4% (SEER/TCR-Medicare) were receiving bDMARDs. About 70% of the patients in the two cohorts received glucocorticoids with no significant time trend increases. The largest predictor of bDMARD utilization was prior use before BC (CDM: odds ratio [OR] 27.15, 95% confidence interval [CI] 19.29–38.19; SEER/TCR: OR 18.98, 95% CI 13.72–26.26). Regional and distant BC compared to in situ or localized were also associated with lower bDMARDs utilization in SEER/TCR-Medicare (OR 0.54, 95% CI 0.36–0.82; OR 0.31, 95% CI 0.13–0.77, respectively).

Conclusion

The utilization of tumor necrosis factor inhibitors and other bDMARDs in patients with RA and recent BC has not increased since 2008. Glucocorticoids utilization remained high. The largest predictor of bDMARD utilization was prior use before BC.