Impact of adalimumab on mortality and cancer risk in patients with inflammatory diseases.

Abstract

e24131 Background: Adalimumab is a commonly used medication for diverse inflammatory conditions. More information is required regarding the potential survival benefits of this medication and its impact on the development of common solid organ malignancies. This retrospective observational study aimed to investigate the potential impact of Adalimumab use in patients with inflammatory pathologies on mortality and the development of common malignancies over a 5-year period. Methods: The TriNetX Global collaborative network was queried from January 2005 to December 2020 for patients 18 years or older diagnosed with rheumatoid arthritis (RA), inflammatory bowel disease, psoriasis, ankylosing spondylitis, hidradenitis suppurativa (HS), and uveitis based on ICD-10-CM codes. Patients were stratified into 2 cohorts based on Adalimumab use after exclusion of genetic susceptibility to malignancies. Propensity score matching was performed for sociodemographics, obesity, cigarette use, alcohol use, and medications, which resulted in 125,097 patients in each cohort. The primary outcome was all-cause mortality. Secondary outcomes were common thoracoabdominal solid malignancies and Merkel cell cancer (CA). Cox proportional Hazard ratios (HRs) were used to compare outcomes over a 5-year follow-up period. Cox Proportional Hazards Model analysis was performed to investigate the effect of various covariates on mortality between both cohorts. Results: Adalimumab use correlated with significantly lower rates of the primary outcome (HR 0.49; 95% CI: 0.47-0.51, p < 0.0001). The Adalimumab cohort also had lower rates of some solid malignancies, including lung cancer (HR 0.67; 95% CI 0.61-0.74, p < 0.0001), Hepatocellular cancer (HR 0.74; 95% CI 0.62-0.88, p = 0.001), prostate cancer (HR 0.71; 95% CI 0.62-0.80, p < 0.0001), and breast cancer (HR 0.81; 95% CI 0.73-0.90, p < 0.0001), No significant difference was seen between Adalimumab users and the control cohort for Merkel cell CA (HR 0.57; 95% CI: 0.27-1.19, p = 0.130), colorectal CA (HR 0.95; 95% CI: 0.84-1.09, p = 0.471), pancreatic CA (HR 0.89; 95% CI: 0.72-1.10, p = 0.261), Renal and renal pelvis CA (HR 0.87; 95% CI: 0.73-1.03, p = 0.097), or with nephrolithiasis, which was used as a falsification endpoint. Aalen-Johansen Cumulative Incidence curve was plotted to evaluate the cumulative incidence of competing risks for various malignancies in the Adalimumab cohort, with the highest being breast cancer (3.43%), prostate cancer (2.52%) and urinary tract cancers (2.21%). Cox regression revealed diverse covariates with higher hazards of mortality, notably male sex, Crohn’s disease, RA, HS, and various CAs. Conclusions: Among patients with certain inflammatory disorders, Adalimumab use was associated with a significant survival benefit and significantly lower rates of lung, hepatocellular, prostate and breast cancers but no higher rates of Merckel Cell CA over a 5-year period.