Use of disease modifying anti-rheumatic drugs and risk of multiple myeloma in US Veterans with rheumatoid arthritis
Abstract Background Biologic (b) and targeted synthetic (ts) disease-modifying anti-rheumatic drugs (DMARDs) used in the management of rheumatoid arthritis (RA) target inflammatory pathways implicated in the pathogenesis of multiple myeloma (MM). It is unknown whether use of b/tsDMARDs affects the i...
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2025-01-01
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| Series: | BMC Rheumatology |
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| Online Access: | https://doi.org/10.1186/s41927-025-00457-3 |
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| author | Kate Tokareva Alexander C. Peterson Aaron Baraff Sarah P. Chung Jennifer Barton Joshua F. Baker Bryant R. England Ted R. Mikuls Nicholas L. Smith David G. Coffey Noel S. Weiss Namrata Singh |
| author_facet | Kate Tokareva Alexander C. Peterson Aaron Baraff Sarah P. Chung Jennifer Barton Joshua F. Baker Bryant R. England Ted R. Mikuls Nicholas L. Smith David G. Coffey Noel S. Weiss Namrata Singh |
| author_sort | Kate Tokareva |
| collection | DOAJ |
| description | Abstract Background Biologic (b) and targeted synthetic (ts) disease-modifying anti-rheumatic drugs (DMARDs) used in the management of rheumatoid arthritis (RA) target inflammatory pathways implicated in the pathogenesis of multiple myeloma (MM). It is unknown whether use of b/tsDMARDs affects the incidence of MM. Methods In this cohort study using Veterans Health Administration (VHA) data, we identified Veterans newly diagnosed with RA from 1/1/2002 to 12/31/2018 using diagnostic codes and medication fills. DMARD exposure was categorized as follows: conventional synthetic (cs)DMARDs; bDMARDs, which included tumor necrosis factor inhibitors (TNFi), non-TNFi; and a tsDMARD, tofacitinib. A Cox proportional hazards model with time-varying exposure was used to estimate the hazard ratio for developing MM among those who received b/tsDMARD medications relative to b/tsDMARD-naïve persons. Results 27,540 veterans with RA met eligibility criteria of whom 8322 (30%) took a b/tsDMARD during follow-up. There were 77 incident cases of MM over 192,000 person-years of follow-up. The age-adjusted incidence rate (IR) of MM among b/tsDMARD-naïve patients was 0.37 (95% CI 0.28–0.49) per 1000 person-years and 0.42 among current or former b/tsDMARD users (95% CI 0.25–0.65). Adjusting for age and other demographic characteristics, the hazard ratio for MM associated with use of b/tsDMARDs was 1.32 (95% CI 0.78, 2.26). Conclusion In this study of Veterans with RA, the rate of MM did not differ between b/tsDMARD and csDMARD users. The relatively short duration of follow-up and few events limited our power to detect treatment-related differences in MM risk. |
| format | Article |
| id | doaj-art-03f80054ab05491ea9b56899f06ce1a9 |
| institution | Kabale University |
| issn | 2520-1026 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Rheumatology |
| spelling | doaj-art-03f80054ab05491ea9b56899f06ce1a92025-01-19T12:42:51ZengBMCBMC Rheumatology2520-10262025-01-01911610.1186/s41927-025-00457-3Use of disease modifying anti-rheumatic drugs and risk of multiple myeloma in US Veterans with rheumatoid arthritisKate Tokareva0Alexander C. Peterson1Aaron Baraff2Sarah P. Chung3Jennifer Barton4Joshua F. Baker5Bryant R. England6Ted R. Mikuls7Nicholas L. Smith8David G. Coffey9Noel S. Weiss10Namrata Singh11University of WashingtonERIC, VA Puget SoundERIC, VA Puget SoundVirginia MasonPortland VA Medical Center and OHSUCorporal Michael J. Crescenz VA Medical CenterUniversity of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care SystemUniversity of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care SystemERIC, VA Puget SoundDivision of Myeloma, University of MiamiDepartment of Epidemiology, University of WashingtonDepartment of Epidemiology, University of WashingtonAbstract Background Biologic (b) and targeted synthetic (ts) disease-modifying anti-rheumatic drugs (DMARDs) used in the management of rheumatoid arthritis (RA) target inflammatory pathways implicated in the pathogenesis of multiple myeloma (MM). It is unknown whether use of b/tsDMARDs affects the incidence of MM. Methods In this cohort study using Veterans Health Administration (VHA) data, we identified Veterans newly diagnosed with RA from 1/1/2002 to 12/31/2018 using diagnostic codes and medication fills. DMARD exposure was categorized as follows: conventional synthetic (cs)DMARDs; bDMARDs, which included tumor necrosis factor inhibitors (TNFi), non-TNFi; and a tsDMARD, tofacitinib. A Cox proportional hazards model with time-varying exposure was used to estimate the hazard ratio for developing MM among those who received b/tsDMARD medications relative to b/tsDMARD-naïve persons. Results 27,540 veterans with RA met eligibility criteria of whom 8322 (30%) took a b/tsDMARD during follow-up. There were 77 incident cases of MM over 192,000 person-years of follow-up. The age-adjusted incidence rate (IR) of MM among b/tsDMARD-naïve patients was 0.37 (95% CI 0.28–0.49) per 1000 person-years and 0.42 among current or former b/tsDMARD users (95% CI 0.25–0.65). Adjusting for age and other demographic characteristics, the hazard ratio for MM associated with use of b/tsDMARDs was 1.32 (95% CI 0.78, 2.26). Conclusion In this study of Veterans with RA, the rate of MM did not differ between b/tsDMARD and csDMARD users. The relatively short duration of follow-up and few events limited our power to detect treatment-related differences in MM risk.https://doi.org/10.1186/s41927-025-00457-3Tumor necrosis factor inhibitorsRheumatoid arthritisMultiple myeloma |
| spellingShingle | Kate Tokareva Alexander C. Peterson Aaron Baraff Sarah P. Chung Jennifer Barton Joshua F. Baker Bryant R. England Ted R. Mikuls Nicholas L. Smith David G. Coffey Noel S. Weiss Namrata Singh Use of disease modifying anti-rheumatic drugs and risk of multiple myeloma in US Veterans with rheumatoid arthritis BMC Rheumatology Tumor necrosis factor inhibitors Rheumatoid arthritis Multiple myeloma |
| title | Use of disease modifying anti-rheumatic drugs and risk of multiple myeloma in US Veterans with rheumatoid arthritis |
| title_full | Use of disease modifying anti-rheumatic drugs and risk of multiple myeloma in US Veterans with rheumatoid arthritis |
| title_fullStr | Use of disease modifying anti-rheumatic drugs and risk of multiple myeloma in US Veterans with rheumatoid arthritis |
| title_full_unstemmed | Use of disease modifying anti-rheumatic drugs and risk of multiple myeloma in US Veterans with rheumatoid arthritis |
| title_short | Use of disease modifying anti-rheumatic drugs and risk of multiple myeloma in US Veterans with rheumatoid arthritis |
| title_sort | use of disease modifying anti rheumatic drugs and risk of multiple myeloma in us veterans with rheumatoid arthritis |
| topic | Tumor necrosis factor inhibitors Rheumatoid arthritis Multiple myeloma |
| url | https://doi.org/10.1186/s41927-025-00457-3 |
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