Is there a greater cancer or infection risk with abatacept treatment for rheumatoid arthritis?

This study investigated the risk of infection and cancer with targeted disease-modifying anti-rheumatic drugs (tDMARDs).

They found that the cancer risk is slightly higher with abatacept (Orencia) compared to other tDMARDs. 

Rheumatoid arthritis (RA) is a long-term autoimmune condition. Excessive inflammation leads to painful swelling in the joints and disability. Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat RA. Conventional DMARDs (csDMARDs) target proteins or receptors that are involved in many immune functions. In recent years, targeted DMARDs (tDMARDs) have been developed. These drugs are more selective than some csDMARDs. This may improve RA management. 

Abatacept (ABT) is a biological DMARD (bDMARD). It is also considered a tDMARD because it targets a specific protein on immune T cells. ABT has a unique mechanism of action. The long-term safety of ABT is unknown. DMARDs suppress the immune system. This could make the body more susceptible to cancer or infection. Some studies suggest that DMARDs increase infection and cancer risk. It is unclear if ABT increases the risks of cancer or infection compared to other tDMARDs. 

This study included 92,017 patients with RA. 35.9% of patients were taking ABT. Patient data were obtained from 3 databases. The rates of cancer and infection were analyzed. The risks of infection and cancer were calculated. 

Cancer was 9% higher with ABT treatment compared to other DMARDs. The risk for specific cancers was not different between ABT and other tDMARDs. The risk of infection was similar between ABT and other tDMARDs. 

The authors concluded that the cancer risk was slightly higher with ABT compared to other tDMARDs.

Patients taking ABT were more likely to be female and older. They were also more likely to have previous tDMARD or csDMARD treatment. These factors may affect the cancer risk. More controlled studies are needed to determine the risks. 

If you have any concerns regarding RA management please consult with your physician.