Background: For 20 years, bDMARDs have revolutionized the management of patients with inflammatory rheumatism, but their use is limited when patients have a history of cancer in remission for less than 5 years. Current data on their use in this specific context are insufficient, although recent studies have shown that TNFi does not cause an excess risk of new or relapse of cancer.

Objectives: The objective of this study is to identify the factors for early introduction (<5 years) of bDMARDs in this specific context.

Methods: This is an observational, retrospective and multicenter French study based on the “réseau RIC” database, including patients over 18 years old that have inflammatory rheumatism (rheumatoid arthritis [RA], psoriatic arthritis [PsA] or spondyloarthropathy [SA]) treated with bDMARD, with a history of cancer, between 2008 and 2024. Were excluded patients with a history of cancer developed more than 5 years before inflammatory rheumatism and basal cell carcinomas. Factors associated with an initiation of a bDMARDs were assessed using a univariate logistic regression model. Then, the significant factors at the level of 0.10 were introduced into a multivariable logistic regression model.

Results: One hundred fifty-six patients have been included (59% of women, mean age of 59,3 years old at the time of the cancer diagnosis), with 70.0% of RA (n=109), 18,5% of SA (n=29) and 11.5% PsA (n=18). They were 11.5% (n=18) of hemopathy and 88.5% (n=138) of solid tumor, including 36% (n=54) of gynecological cancer, 21% (n=33) of urological cancer, 18% (n=30) of skin cancer, 10% (n=19) of digestive cancer, 7% (n=16) of pulmonary cancer, and 8% of other cancer (endocrinological, neurological cancer). 67% (n=83) of patients had remission of the oncological pathology within a mean time of 1.87 years. 9.6% (n=15) of patients died, including 53% (n=9) who died from cancer. 11.5% (n=18) of patients had developed their cancer before their inflammatory rheumatism, whereas 88,5% (n=138) had inflammatory arthritis disease before cancer. Among solid tumor patients (n=138), 67.4% (n=93) had received at least one bDMARD before cancer diagnosis, 57.2% (n=79) were treated with bDMARD at the time of cancer diagnosis, and 17.7% (n=14) continued their treatment despite this diagnosis. Before cancer diagnosis, patients had received TNFi in 69% of cases (etanercept (n= 51), adalimumab (n= 48), infliximab (n= 17), golimumab (n= 10), certolizumab (n= 7)), IL6 in 11,4% of cases (tocilizumab (n= 21), sarilumab (n= 1)), abatacept in 8.3% of cases (n=16), JAKi in 4,7% of cases (n tofacitinib (n= 5), baricitinib (n= 4)), IL17 in 3.6% of cases (secukinumab (n= 5), ixekizumab (n = 2)), rituximab in 2.6% of cases (n=5), and ustekimumab in 0.4% of cases (n=1). Among patients without bDMARD at the time of the solid tumor diagnosis (n=78), 52,6% (n=41) were again treated with bDMARD after the diagnosis of cancer, within a mean period of 1.97 years after remission of cancer, and 70% of patients changed therapeutic class. Between 2008 and 2013, 5% of patients resumed bDMARD (n=2); between 2013 and 2018, 14.6% of patients resumed bDMARD (n=6), and after 2018, 80.4% of patients resumed bDMARD (n=33). The most prescribed bDMARD after cancer diagnosis was Rituximab in 49% of cases (n=44), followed by TNFi in 33% of cases (n=33), and Abatacept in 6% of cases (n=13). In the solid tumor group, 55% (n=76) of patients had a remission of oncological pathology, including 57 patients (75%) in the “resumption of biotherapy” group and 18 patients (24%) in the “non-resumption of biotherapy” group. Having RA (OR =1.49 (0.56-2.66 p=0.007) or SA (OR= 1.44 (0.65-2.22) p=0.026) is significantly associated with the retreatment by a bDMARD and the number of biologics before the cancer predict the non-retreatment by a bDMARD (OR = 0.2316 (0.1155 -2.005) p= 0.045). Age or date at cancer diagnosis and disease activity were not significantly associated with the retreatment by a bDMARD.

Conclusion: After a cancer diagnosis, rituximab and TNFi are the preferred bDMARDs for inflammatory rheumatism (RA, SA, or PsA). The retreatment is more frequent in RA and SA than in PsA and in patients who had less bDMARDs before the cancer. Most patients change therapeutic classes after a cancer diagnosis. The period after 2018 seems to influence the early resumption of bDMARDs for inflammatory rheumatism after a cancer diagnosis.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.