Long-term side effects of modern treatment for rheumatoid arthritis

Janus kinase inhibitors (JAKi) and biologics are the cornerstone of modern treatment for rheumatoid arthritis (RA). But there have been concerns over long-term side effects. New data from a national healthcare database offer reassuring findings for overall cancers and cardiovascular disease (CVD).

Patients with inflammatory rheumatic diseases have an increased risk of CVD compared to the general population.1 In acknowledgement of this, EULAR – the European Alliance of Associations for Rheumatology – has published recommendations for cardiovascular risk management in patients with a range of rheumatic and musculoskeletal diseases, including RA.

At the 2023 EULAR annual congress, Ahn and colleagues present data on the risks of cancer and CVD in people with seropositive RA (SPRA) who had been treated with JAKi or biologics. Information was collected for over 100,000 people who had a case of new-onset SPRA logged between 2010–2020 in the national healthcare database of the Republic of South Korea.

The research then looked for events of overall and site-specific cancers and CVD outcomes, including deep vein thrombosis, pulmonary embolism, and composite cardiovascular events.

The results showed that – compared with people who received only conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) – the incidence rate ratio of overall cancers and CVD in those receiving JAKi or biologics were 0.88 and 0.91, respectively. JAKi did not confer a greater risk of overall CVD or cancer compared with other biologics or csDMARDs. This means overall cancer and CVD incidence were not increased in people with SPRA treated with JAKi/biologics, and were relatively lower than in csDMARD-only patients, underscoring the need for optimal control of disease activity in order to mitigate risks.

However, the authors note that site-specific lung, liver, prostate, and skin cancers were more frequent in people using JAKi/biologics – a finding which requires further investigation.

Overall, this work is reassuring with regards to overall cancers and CVD, but there is a need to keep collecting data in order to support risk management in clinical practice."

Sung Soo Ahn, lead author