Would you switch to a TNFi if a patient developed squamous cell skin cancer on abatacept after failure of methotrexate for seropositive RA?

All biologics or immunosuppressants have been associated with various rates of skin cancers. The decision to change or continue biologics should be based on disease activity through shared decision-making with the patient. The need for frequent skin examinations and treatment through their dermatologist while on bDMARDS is imperative since early identification/treatment is generally curative. Mechanistically, if a patient has extensive recurrent skin cancers where adjuvant immune checkpoint ther...

Abatacept has been linked to an increased risk of non-melanoma skin cancers, although other bDMARDs have also been implicated. Across 9 RCTs in >2500 RA patients, the incidence of NMSC was not significantly higher with Abatacept than placebo. Change in therapy should occur and may include TNFis as well as IL-6Rs. It is important to make the decision regarding treatment in consultation between the rheumatologist and oncologist.

Simon et al., PMID 37932010