Tumour necrosis factor blockers do not increase overall tumour risk in patients with rheumatoid arthritis, but may be associated with an increased risk of lymphomas. Issue 5 (4th February 2005)

• Record Type: Journal Article
• Authors: Geborek, P; Bladström, A; Turesson, C; Gulfe, A; Petersson, I F; Saxne, T; Olsson, H; Jacobsson, L T H
• Is Part Of: Annals of the rheumatic diseases. Volume 64:Issue 5(2005)
• Page Start: 699
• Page End: 703
• Publication Date: 2005-02-04
• Subjects: DAS28, 28 joint count Disease Activity Score -- DMARD, disease modifying antirheumatic drug -- HAQ, Health Assessment Questionnaire -- RA, rheumatoid arthritis -- RR, relative risk -- SIR, standardised incidence ratio -- SSATG, South Swedish Arthritis Treatment Group -- TNF, tumour necrosis factor; anti-tumour necrosis factor -- cancer -- lymphomas -- rheumatoid arthritis; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/ard.2004.030528
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Objective: To determine whether TNF blockers increase tumour risk in patients with RA. Material and methods: The South Swedish Arthritis Treatment Group register (SSATG) comprises over 90% of anti-TNF treated patients with RA in the area. 757 patients treated with etanercept or infliximab included between 1 February 1999 and 31 December 2002 were identified. 800 patients with conventional antirheumatic treatment in a community based cohort served as a comparison cohort. Tumours and deaths were identified in the cancer registry and population census registers. Patients were followed up from initiation of anti-TNF treatment or 1 July 1997 for the comparison group, until death or 31 December 2002. Results: In the anti-TNF group, 16 tumours (5 lymphomas) were identified in 1603 person-years at risk, and in the comparison group 69 tumours (2 lymphomas) in 3948 person-years. Standardised incidence ratios (SIRs) for total tumour relative risk for the anti-TNF group and the comparison group were 1.1 (95% confidence interval (CI) 0.6 to 1.8) and 1.4 (95% CI 1.1 to 1.8), respectively. The lymphoma relative risk (RR) was 11.5 (95% CI 3.7 to 26.9) and 1.3 (95% CI 0.2 to 4.5), respectively The total tumour RR excluding lymphoma was 0.79 (95% CI 0.4 to 1.42) and 1.39 (95% CI 1.08 to 1.76), respectively. Proportional hazard analysis for lymphomas yielded RR 4.9 (95% CI 0.9 to 26.2) in anti-TNF treated versus untreated patients. Conclusion: Community based patients with RA treated conventionally had an increased overall tumour risk compared with the background population. A possible additional increased risk for lymphoma associated with TNF blockers was based on few cases and needs confirmation.