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Anti-tumour necrosis factor therapy in rheumatoid arthritis and risk of malignant lymphomas:relative risks and time-trends in the Swedish Biologics Register

Askling, J; Baecklund, E; Granath, F; Geborek, Pierre LU ; Fored, M.; Backlin, C; Bertilsson, L; Coster, L; Jacobsson, L and Rantapaa-Dahlqvist, S, et al. (2009) In Annals of the Rheumatic Diseases 68(5). p.648-653
Abstract
Background: Tumour necrosis factor (TNF) antagonists have proved effective as treatment against rheumatoid arthritis ( RA), but the unresolved issue of whether the use of anti-TNF therapy increases the already elevated risk of lymphoma in RA remains a concern. Methods: Using the Swedish Biologics Register (ARTIS), the Swedish Cancer Register, pre-existing RA cohorts and cross-linkage with other national health and census registers, a national RA cohort (n = 67 743) was assembled and patients who started anti-TNF therapy between 1998 and July 2006 ( n = 6604) were identified. A general population comparator ( n = 471 024) was also assembled and the incidence of lymphomas from 1999 to 31 December 2006 was assessed and compared in these... (More)
Background: Tumour necrosis factor (TNF) antagonists have proved effective as treatment against rheumatoid arthritis ( RA), but the unresolved issue of whether the use of anti-TNF therapy increases the already elevated risk of lymphoma in RA remains a concern. Methods: Using the Swedish Biologics Register (ARTIS), the Swedish Cancer Register, pre-existing RA cohorts and cross-linkage with other national health and census registers, a national RA cohort (n = 67 743) was assembled and patients who started anti-TNF therapy between 1998 and July 2006 ( n = 6604) were identified. A general population comparator ( n = 471 024) was also assembled and the incidence of lymphomas from 1999 to 31 December 2006 was assessed and compared in these individuals. Results: Among the 6604 anti-TNF-treated RA patients, 26 malignant lymphomas were observed during 26 981 person-years of follow-up, which corresponded to a relative risk (RR) of 1.35 (95% CI 0.82 to 2.11) versus anti-TNF-naive RA patients ( 336 lymphomas during 365 026 person-years) and 2.72 ( 95% CI 1.82 to 4.08) versus the general population comparator ( 1568 lymphomas during 3 355 849 person-years). RA patients starting anti-TNF therapy in 1998-2001 accounted for the entire increase in lymphoma risk versus the two comparators. By contrast, RR did not vary significantly by time since start of first treatment or with the accumulated duration of treatment, nor with the type of anti-TNF agent. Conclusion: Overall and as used in routine care against RA, TNF antagonists are not associated with any major further increase in the already elevated lymphoma occurrence in RA. Changes in the selection of patients for treatment may influence the observed risk. (Less)
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Contribution to journal
publication status
published
subject
in
Annals of the Rheumatic Diseases
volume
68
issue
5
pages
648 - 653
publisher
British Medical Association
external identifiers
  • wos:000265168500007
  • scopus:66149084485
ISSN
1468-2060
DOI
10.1136/ard.2007.085852http://dx.doi.org/10.1136/ard.2007.085852
language
English
LU publication?
yes
id
3384b353-7771-48c0-8ba7-15ab402d0c77 (old id 1400396)
date added to LUP
2009-06-15 14:16:01
date last changed
2017-11-26 03:38:08
@article{3384b353-7771-48c0-8ba7-15ab402d0c77,
  abstract     = {Background: Tumour necrosis factor (TNF) antagonists have proved effective as treatment against rheumatoid arthritis ( RA), but the unresolved issue of whether the use of anti-TNF therapy increases the already elevated risk of lymphoma in RA remains a concern. Methods: Using the Swedish Biologics Register (ARTIS), the Swedish Cancer Register, pre-existing RA cohorts and cross-linkage with other national health and census registers, a national RA cohort (n = 67 743) was assembled and patients who started anti-TNF therapy between 1998 and July 2006 ( n = 6604) were identified. A general population comparator ( n = 471 024) was also assembled and the incidence of lymphomas from 1999 to 31 December 2006 was assessed and compared in these individuals. Results: Among the 6604 anti-TNF-treated RA patients, 26 malignant lymphomas were observed during 26 981 person-years of follow-up, which corresponded to a relative risk (RR) of 1.35 (95% CI 0.82 to 2.11) versus anti-TNF-naive RA patients ( 336 lymphomas during 365 026 person-years) and 2.72 ( 95% CI 1.82 to 4.08) versus the general population comparator ( 1568 lymphomas during 3 355 849 person-years). RA patients starting anti-TNF therapy in 1998-2001 accounted for the entire increase in lymphoma risk versus the two comparators. By contrast, RR did not vary significantly by time since start of first treatment or with the accumulated duration of treatment, nor with the type of anti-TNF agent. Conclusion: Overall and as used in routine care against RA, TNF antagonists are not associated with any major further increase in the already elevated lymphoma occurrence in RA. Changes in the selection of patients for treatment may influence the observed risk.},
  author       = {Askling, J and Baecklund, E and Granath, F and Geborek, Pierre and Fored, M. and Backlin, C and Bertilsson, L and Coster, L and Jacobsson, L and Rantapaa-Dahlqvist, S and Saxne, Tore and van Vollenhoven, R and Klareskog, L and Feltelius, N},
  issn         = {1468-2060},
  language     = {eng},
  number       = {5},
  pages        = {648--653},
  publisher    = {British Medical Association},
  series       = {Annals of the Rheumatic Diseases},
  title        = {Anti-tumour necrosis factor therapy in rheumatoid arthritis and risk of malignant lymphomas:relative risks and time-trends in the Swedish Biologics Register},
  url          = {http://dx.doi.org/10.1136/ard.2007.085852http://dx.doi.org/10.1136/ard.2007.085852},
  volume       = {68},
  year         = {2009},
}