Malcolm Smith, MD
In patients with rheumatoid arthritis (RA), are anti–tumor necrosis factor α (anti-TNFα) therapies associated with increased short- or medium-term risk for cancer?
Retrospective cohort study with linkage of several national registers; median follow-up was 3.6 years.
Population-based study in Sweden.
67 743 patients with RA who were alive in 1998 (mean age 64 y at start of follow-up, 73% women) were identified from the Swedish Inpatient, Outpatient, and Early RA Registers. Linkage with the Swedish Biologics Register identified 6604 patients > 16 years of age who started anti-TNFα therapy between 1998 and 2006 (mean age at start of anti-TNFα 55 y, 75% women). Patients with RA who started methotrexate (n = 5989) or a second nonbiologic disease-modifying antirheumatic drug (DMARD) (n = 1838) during the same period were also identified. Patients with a history of cancer were excluded.
First primary cancer, identified by linkage with the Swedish Cancer Register.
Patients with RA who started anti-TNFα therapy were not at greater risk for cancer than those who were anti-TNFα–naïve, started methotrexate, or started nonbiologic DMARD combination therapy (Table). Risks were similar across several periods after start of anti-TNFα therapy. Among patients who started this therapy, 51% first used infliximab, 35% used etanercept, and 14% used adalimumab. Cancer rates among these groups were 10.2, 7.4, and 12.0 /1000 person-years, respectively. The adjusted relative risks for cancer, compared with anti-TNFα–naïve patients, were 1.1 (95% CI 0.9 to 1.3) for patients first receiving infliximab, 1.3 (CI 0.9 to 2.0) for those first receiving adalimumab, and 0.78 (CI 0.6 to 1.0) for those first receiving etanercept (P = 0.034). Differences in cancer risk among the 3 drugs were strongest in the first year after the start of treatment.
Anti-TNFα therapy was not associated with increased short- or medium-term risk for cancer in patients with rheumatoid arthritis.
Associations between anti–tumor necrosis factor α (anti-TNFα) therapy and first primary cancer in patients with rheumatoid arthritis*
*DMARD = disease-modifying antirheumatic drug; CI defined in Glossary.
†Adjusted for age, sex, county of residence, marital status, and comorbid conditions.
Smith M. Anti-TNFα therapy did not increase short- or medium-term risk for cancer in patients with rheumatoid arthritis. Ann Intern Med. 2010;152:JC5–13. doi: 10.7326/0003-4819-152-10-201005180-02013
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Published: Ann Intern Med. 2010;152(10):JC5-13.
Cancer Screening/Prevention, Hematology/Oncology, Prevention/Screening, Rheumatoid Arthritis, Rheumatology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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