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To compare the risk of new primary cancer, locoregional progression or metastasis across different disease-modifying antirheumatic drugs (DMARDs) strategies in real-world patients with rheumatoid arthritis (RA) and prior cancer.

The ARthritis and CAncer registry is a nationwide retrospective study, including patients with RA and prior cancer. Collected variables included RA characteristics, DMARDs received, cancer type and demographics. The primary outcome was the occurrence of new primary cancer, locoregional progression or metastasis during follow-up. Adjusted Cox regression models were used to estimate HRs for cancer events. Treatment strategies involving conventional synthetic (cs)DMARDs served as the reference for comparison.

Among 728 patients with RA, 80 cases of cancer were identified over a cumulative exposure period of 11 022 years, with an overall cancer incidence rate of 7.3 (95% CI 5.8 to 9.0) per 1000 person-years. Adjusted HRs for all cancers (95% CI) compared with csDMARDs were 0.94 (0.73 to 1.21) for tumour necrosis factor inhibitors, 1.03 (0.61 to 1.74) for IL6-inhibitors, 0.81 (0.46 to 1.42) for CD20 inhibitors, 0.6 (0.26 to 1.4) for targeted synthetic DMARDs and 0.74 (0.41 to 1.34) for cytotoxic T-lymphocyte-associated protein 4-analogue. No differences in cancer risk were observed after adjusting for duration of exposure, line of advanced therapy or prior cancer status.

This real-world data did not identify differences in the risk of new primary cancer, locoregional progression or metastasis across different DMARDs strategies in patients with RA and prior cancer.