To the Editor:
We were highly interested to read the recent article by Masayoshi Harigai et al., titled “Incidence of malignancies and the association with biological disease‑modifying antirheumatic drugs in Japanese patients with rheumatoid arthritis: a time‑dependent analysis from the IORRA patient registry” [1]. This study provides valuable insights into the incidence of malignancies among Japanese patients with rheumatoid arthritis (RA) and the potential associations with biological disease-modifying antirheumatic drugs (bDMARDs). While the authors have made significant contributions to our understanding of this issue, we would like to highlight other limitations not addressed in the article and offer suggestions for future research improvements.
Anzeige
First, the 6-year follow-up period may be insufficient to fully capture the long-term incidence of malignancies in patients with RA. Certain cancers, particularly those related to chronic inflammation, may take longer to develop. Therefore, future studies should consider extending the follow-up period or employing a phased follow-up design (such as early, mid, and long-term follow-up) to provide a more comprehensive understanding of RA and its treatments, especially the long-term risks associated with bDMARDs. Additionally, implementing a multicenter study design could enhance the generalizability and representativeness of the findings.
Second, despite using a time-dependent Cox proportional hazards model to account for covariates, residual confounding may still be present. For instance, the analysis failed to adequately address factors that significantly influence cancer risk, such as family cancer history [2‐4], lifestyle choices (including diet, physical activity, and smoking) [5‐7], and mental health [8]. Future research would benefit from incorporating these variables to offer a more comprehensive view and help clarify the relationship between bDMARD use and malignancy risk.
Moreover, while the authors noted the impact of disease activity on cancer risk, it is crucial to further explore how other comorbidities (such as diabetes [9, 10], cardiovascular diseases [11], and infections [12]) influence malignancy incidence in patients with RA. By adjusting for these factors in future analyses, researchers could better understand how various health conditions interact with RA treatments and influence cancer risk.
The heterogeneity of bDMARD treatments is another key consideration. Different types of bDMARDs have distinct mechanisms of action and may have varying degrees of impact on cancer risk. Future studies should stratify results by specific bDMARD types to better define their individual effects on cancer incidence.
Anzeige
Finally, the study did not address the crucial impact of socio-economic factors on health outcomes. Access to healthcare, education levels, and socio-economic status significantly influence patient outcomes and treatment adherence [13, 14]. Incorporating these factors into future analyses would help contextualize the findings within a broader understanding of health disparities and provide more nuanced explanations of cancer risk.
Building on the research by Harigai et al., social workers can play a pivotal role in supporting patients with RA and reducing their cancer risk. First, health education and awareness programs can increase patients’ and their families’ understanding of cancer risks, particularly those associated with bDMARD use. Second, social workers can provide psychological support and counseling to help patients cope with emotional stress and develop personalized intervention plans. Additionally, promoting regular health checkups, offering lifestyle guidance, and establishing community support networks are critical for fostering experience-sharing among patients. Social workers should collaborate closely with healthcare professionals, addressing socio-economic factors and providing information on insurance and financial assistance. Lastly, social workers should actively engage in policy advocacy, promoting improved healthcare services and education for patients with RA to enhance their quality of life and reduce cancer risk.
In conclusion, while Harigai et al.’s research significantly advances our understanding of cancer risk in patients with RA treated with bDMARDs, future studies addressing the limitations discussed above will deepen our understanding of the multifactorial influences on malignancy risk. We appreciate the authors’ efforts and look forward to continued progress in this critical area of rheumatological research.
Declarations
Conflict of Interest
Zhongxing Liu has nothing to disclose; Mengzhe Tian has nothing to disclose; Lincheng Duan has nothing to disclose.
Ethical Approval
This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
