Open AccessRisk of malignancies in patients with spondyloarthritis treated with biologics compared with those treated with non-biologics: a systematic review and meta-analysis
Author(s) -
Yu Heng Kwan,
Ka Keat Lim,
Warren Fong,
Hendra Goh,
Li Choo Ng,
Benjamin Haaland,
Jie Kie Phang,
Lian Leng Low,
Joo Guan Yeo,
Feng Huang,
Ying Ying Leung,
Julian Thumboo,
Truls Østbye
Publication year - 2020
Publication title -
therapeutic advances in musculoskeletal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.387
H-Index - 35
eISSN - 1759-7218
pISSN - 1759-720X
DOI - 10.1177/1759720x20925696
Subject(s) - medicine , oncology , meta analysis , dermatology
Background: The aim of our study was to synthesize evidence on the occurrence of malignancy in spondyloarthritis (SpA), from randomized controlled trials (RCTs) comparing biologics with non-biologics and biologics to each other.Methods: We systematically searched Medline, Cochrane Library, EMBASE, Scopus and ClinicalTrials.gov from inception until 31 October 2018. RCTs with ⩾24-week follow-up were included. We extracted data using standardized forms and assessed the risk of bias using the Cochrane Risk of Bias Tool. We performed pair-wise meta-analyses and network meta-analyses to compare the risk of malignancy for each biologics class and SpA type. We reported the Peto odds ratio (OR) of any malignancy along with 95% confidence intervals (95% CI). Bayesian posterior probabilities comparing risk of malignancy of each biologic class with non-biologics were computed as supplementary measures.Results: Fifty-four trials were included; most (44/54) had follow-up 1, they had wide 95% CI and p >0.05. The overall Peto OR comparing biologics with non-biologics was 1.42 (95% CI 0.80–2.53). Only interleukin-17 inhibitors in peripheral SpA had p <0.05 (Peto OR 2.77, 95% CI 1.07–7.13); the posterior probability that the risk was higher than non-biologics was 98%. Stratified analyses revealed no consistent trend by prior exposure to biologics, duration of follow-up, study quality, study-arm crossover, analytical approaches and type of malignancy.Conclusions: Our findings indicate no overall elevated risk of malignancy with biologics in SpA. As our meta-analyses are unable to conclude on the long-term risk, long-term pharmacovigilance of biologics in SpA may still be warranted.