Cancer risk in patients with rheumatoid arthritis treated with anti–tumor necrosis factor α therapies: Does the risk change with the time since start of treatment?
Open Access
- 29 October 2009
- journal article
- research article
- Published by Wiley in Arthritis & Rheumatism
- Vol. 60 (11), 3180-3189
- https://doi.org/10.1002/art.24941
Abstract
Objective To determine the short‐term and medium‐term risks of cancer in patients receiving anti–tumor necrosis factor α (anti‐TNFα) therapies that have proven effective in the treatment of chronic inflammatory conditions. Methods By linking together data from the Swedish Biologics Register, Swedish registers of RA, and the Swedish Cancer Register, we identified and analyzed for cancer occurrence a national cohort of 6,366 patients with RA who first started anti‐TNF therapy between January 1999 and July 2006. As comparators, we used a national biologics‐naive RA cohort (n = 61,160), a cohort of RA patients newly starting methotrexate (n = 5,989), a cohort of RA patients newly starting disease‐modifying antirheumatic drug combination therapy (n = 1,838), and the general population of Sweden. Relative risks (RRs) were estimated using Cox regression analyses, examining overall RR as well as RR by time since the first start of anti‐TNF therapy, by the duration of active anti‐TNF therapy, and by the anti‐TNF agent received. Results During 25,693 person‐years of followup in 6,366 patients newly starting anti‐TNF, 240 first cancers occurred, yielding an RR of 1.00 (95% confidence interval 0.86–1.15) versus the biologics‐naive RA cohort, and similar RRs versus the other 2 RA comparators. RRs did not increase with increasing time since the start of anti‐TNF therapy, nor with the cumulative duration of active anti‐TNF therapy. During the first year following the first treatment start, but not thereafter, dissimilar cancer risks for adalimumab, etanercept, and infliximab were observed. Conclusion During the first 6 years after the start of anti‐TNF therapy in routine care, no overall elevation of cancer risk and no increase with followup time were observed.Keywords
Funding Information
- Swedish Cancer Society
- Stockholm County Council
- ARTIS
- Swedish Biologics Register
- Wyeth-Ayerst
- Schering-Plough
- Abbott Immunology
- Roche
- Bristol-Myers Squibb
- The South Swedish Anti-TNF Register has received funding from the King Gustav V
- Österlund
- Kock Foundations
- Reumatikerförbundet
- Swedish National Board of Health and Welfare
This publication has 18 references indexed in Scilit:
- The safety of anti-tumour necrosis factor treatments in rheumatoid arthritis: meta and exposure-adjusted pooled analyses of serious adverse eventsAnnals Of The Rheumatic Diseases, 2008
- Tumor necrosis factor α antagonist use and cancer in patients with rheumatoid arthritisArthritis & Rheumatism, 2006
- Anti-TNF Antibody Therapy in Rheumatoid Arthritis and the Risk of Serious Infections and MalignanciesJAMA, 2006
- Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritisArthritis & Rheumatism, 2006
- Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonistsAnnals Of The Rheumatic Diseases, 2005
- Tumour necrosis factor blockers do not increase overall tumour risk in patients with rheumatoid arthritis, but may be associated with an increased risk of lymphomasAnnals Of The Rheumatic Diseases, 2005
- NF-κB: tumor promoter or suppressor?Trends in Cell Biology, 2004
- Tumor necrosis factor antagonist therapy and lymphoma development: Twenty‐six cases reported to the Food and Drug AdministrationArthritis & Rheumatism, 2002
- The prevalence of rheumatoid arthritis in SwedenScandinavian Journal of Rheumatology, 1999
- Rheumatoid arthritis and cancer riskEuropean Journal Of Cancer, 1996