Influence of anti–tumor necrosis factor therapy on cancer incidence in patients with rheumatoid arthritis who have had a prior malignancy: Results from the British Society for rheumatology biologics register

Abstract

Objective To explore the influence of anti–tumor necrosis factor (anti‐TNF) therapy upon the incidence of cancer in patients with rheumatoid arthritis (RA) and prior malignancy. Methods Using data from the British Society for Rheumatology Biologics Register, a national prospective observational study established in 2001, we identified 293 patients with a prior malignancy from over 14,000 patients with RA. We compared rates of incident malignancy in 177 anti‐TNF–treated patients and 117 patients with active RA treated with traditional disease‐modifying antirheumatic drugs (DMARDs), all with prior malignancy. One patient switched therapy and contributed to both cohorts. Results The rates of incident malignancy were 25.3 events/1,000 person‐years in the anti‐TNF cohort and 38.3/1,000 person‐years in the DMARD cohort, generating an age‐ and sex‐adjusted incidence rate ratio of 0.58 (95% confidence interval 0.23–1.43) for the anti‐TNF–treated cohort compared with the DMARD cohort. Of the patients with prior melanomas, 3 (18%) of 17 in the anti‐TNF cohort developed an incident malignancy, compared with 0 of 10 in the DMARD cohort. Conclusion The way in which UK rheumatologists are selecting patients with RA and prior malignancy to receive anti‐TNF therapy is not leading to an increased risk of incident malignancy. Although reassuring, these results should not be interpreted as indicating that it is safe to treat all RA patients with prior malignancy with anti‐TNF therapy.

Shown for reading. Its publisher allows quoting it, not republishing it.

References 21

1. 1.

   Rink L, Kirchner H. Recent progress in the tumor necrosis factor-alpha field. Int Arch Allergy Immunol. 1996;111:199-209.

   Not in our library10.1159/000237369

2. 2.

   Eggermont AM, Ten Hagen TL. Tumor necrosis factor-based isolated limb perfusion for soft tissue sarcoma and melanoma: ten years of successful antivascular therapy. Curr Oncol Rep. 2003;5:79-80.

   Not in our library10.1007/s11912-003-0091-x

3. 3.

   Balkwill F. TNF-alpha in promotion and progression of cancer. Cancer Metastasis Rev. 2006;25:409-16.

   Not in our library10.1007/s10555-006-9005-3

4. 4.

   Brown ER, Charles KA, Hoare SA, Rye RL, Jodrell DI, Aird RE, et al. A clinical study assessing the tolerability and biological effects of infliximab, a TNF-alpha inhibitor, in patients with advanced cancer. Ann Oncol. 2008;19:1340-6.

   Not in our library10.1093/annonc/mdn054

5. 5.

   Maini R, St Clair EW, Breedveld F, Furst D, Kalden J, Weisman M, ATTRACT Study Group, et al. Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. Lancet. 1999;354:1932-9.

   Not in our library10.1016/s0140-6736(99)05246-0

6. 6.

   Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH, Keystone EC, et al. A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med. 2000;343:1586-93.

   Not in our library10.1056/nejm200011303432201

7. 7.

   Keystone EC, Kavanaugh AF, Sharp JT, Tannenbaum H, Hua Y, Teoh LS, et al. Radiographic, clinical, and functional outcomes of treatment with adalimumab (a human anti-tumor necrosis factor monoclonal antibody) in patients with active rheumatoid arthritis receiving concomitant methotrexate therapy: a randomized, placebo-controlled, 52-week trial. Arthritis Rheum. 2004;50:1400-11.

   Not in our library10.1002/art.20217

8. 8.

   Ledingham J, Deighton C. Update on the British Society for Rheumatology guidelines for prescribing TNFalpha blockers in adults with rheumatoid arthritis (update of previous guidelines of April 2001). Rheumatology (Oxford). 2005;44:157-63.

   Not in our library10.1093/rheumatology/keh464

9. 9.

   Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59:762-84.

   Not in our library10.1002/art.23721

10. 10.

    Watson K, Symmons D, Griffiths I, Silman A. The British Society for Rheumatology Biologics Register. Ann Rheum Dis. 2005;64(Suppl 4):iv42-3.

    Not in our library10.1136/ard.2005.042499

11. 11.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

12. 12.

    Jonsson B, Kobelt G, Smolen J. The burden of rheumatoid arthritis and access to treatment: uptake of new therapies. Eur J Health Econ. 2008;8(Suppl 2):S61-86.

    Not in our library10.1007/s10198-007-0089-7

13. 13.

    Prevoo ML, van 't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight–joint counts: development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44-8.

    Not in our library10.1002/art.1780380107

14. 14.

    Kirwan JR, Reeback JS. Stanford Health Assessment Questionnaire modified to assess disability in British patients with rheumatoid arthritis. Br J Rheumatol. 1986;25:206-9.

    Not in our library10.1093/rheumatology/25.2.206

15. 15.

    Dickinson HO, Salotti JA, Birch PJ, Reid MM, Malcolm A, Parker L. How complete and accurate are cancer registrations notified by the National Health Service Central Register for England and Wales? J Epidemiol Community Health. 2001;55:414-22.

    Not in our library10.1136/jech.55.6.414

16. 16.

    Peduzzi P, Concato J, Feinstein AR, Holford TR. Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates. J Clin Epidemiol. 1995;48:1503-10.

    Not in our library10.1016/0895-4356(95)00048-8

17. 17.

    Baecklund E, Iliadou A, Askling J, Ekbom A, Backlin C, Granath F, et al. Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis. Arthritis Rheum. 2006;54:692-701.

    Not in our library10.1002/art.21675

18. 18.
    Reduction in the incidence of myocardial infarction in patients with rheumatoid arthritis who respond to anti–tumor necrosis factor α therapy: Results from the British Society for Rheumatology Biologics Register · 2007

    No notice
19. 19.
    Serious infection following anti–tumor necrosis factor α therapy in patients with rheumatoid arthritis: Lessons from interpreting data from observational studies · 2007

    No notice
20. 20.

    Askling J, Bongartz T. Malignancy and biologic therapy in rheumatoid arthritis. Curr Opin Rheumatol. 2008;20:334-9.

    Not in our library10.1097/bor.0b013e3282f7c706

21. 21.

    Wolfe F, Michaud K. Biologic treatment of rheumatoid arthritis and the risk of malignancy: analyses from a large US observational study. Arthritis Rheum. 2007;56:2886-95.

    Not in our library10.1002/art.22864

Cited by papers we hold 1

• Risk of solid cancer in patients exposed to anti-tumour necrosis factor therapy: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis · 2015
  No notice

Reads

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.