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Haematopoietic malignancies in rheumatoid arthritis: lymphoma risk and characteristics after exposure to tumour necrosis factor antagonists

Askling, J; Fored, CM; Baecklund, E; Brandt, L; Backlin, C; Ekbom, A; Sundstrom, C; Bertilsson, L; Coster, L and Geborek, Pierre LU , et al. (2005) In Annals of the Rheumatic Diseases 64(10). p.1414-1420
Abstract
Background: Patients with rheumatoid arthritis ( RA) are at increased risk of malignant lymphomas, and maybe also of leukaemia and multiple myeloma. The effect of tumour necrosis factor (TNF) antagonists on lymphoma risk and characteristics is unclear. Objective: To assess expected rates and relative risks of haematopoietic malignancies, especially those associated with TNF antagonists, in large population based cohorts of patients with RA. Methods: A population based cohort study was performed of patients with RA ( one prevalent cohort (n = 53 067), one incident cohort ( n = 3703), and one TNF antagonist treated cohort 1999 through 2003 ( n = 4160)), who were linked with the Swedish Cancer Register. Additionally, the lymphoma specimens... (More)
Background: Patients with rheumatoid arthritis ( RA) are at increased risk of malignant lymphomas, and maybe also of leukaemia and multiple myeloma. The effect of tumour necrosis factor (TNF) antagonists on lymphoma risk and characteristics is unclear. Objective: To assess expected rates and relative risks of haematopoietic malignancies, especially those associated with TNF antagonists, in large population based cohorts of patients with RA. Methods: A population based cohort study was performed of patients with RA ( one prevalent cohort (n = 53 067), one incident cohort ( n = 3703), and one TNF antagonist treated cohort 1999 through 2003 ( n = 4160)), who were linked with the Swedish Cancer Register. Additionally, the lymphoma specimens for the 12 lymphomas occurring in patients with RA exposed to TNF antagonists in Sweden 1999 through 2004 were reviewed. Results: Study of almost 500 observed haematopoietic malignancies showed that prevalent and incident patients with RA were at increased risk of lymphoma ( SIR = 1.9 and 2.0, respectively) and leukaemia ( SIR = 2.1 and 2.2, respectively) but not of myeloma. Patients with RA treated with TNF antagonists had a tripled lymphoma risk ( SIR = 2.9) compared with the general population. After adjustment for sex, age, and disease duration, the lymphoma risk after exposure to TNF antagonists was no higher than in the other RA cohorts. Lymphomas associated with TNF antagonists had characteristics similar to those of other RA lymphomas. Conclusion: Overall, patients with RA are at equally increased risks for lymphomas and leukaemias. Patients with RA treated with TNF antagonists did not have higher lymphoma risks than other patients with RA. Prolonged observation is needed to determine the long term effects of TNF antagonists on lymphoma risk. (Less)
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Contribution to journal
publication status
published
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in
Annals of the Rheumatic Diseases
volume
64
issue
10
pages
1414 - 1420
publisher
British Medical Association
external identifiers
  • pmid:15843454
  • wos:000231875800007
  • scopus:27744520447
ISSN
1468-2060
DOI
10.1136/ard.2004.033241
language
English
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yes
id
a9b43f55-e5e9-46b0-95d9-2eb7d231fc22 (old id 224663)
date added to LUP
2007-08-14 11:34:47
date last changed
2017-11-19 04:12:38
@article{a9b43f55-e5e9-46b0-95d9-2eb7d231fc22,
  abstract     = {Background: Patients with rheumatoid arthritis ( RA) are at increased risk of malignant lymphomas, and maybe also of leukaemia and multiple myeloma. The effect of tumour necrosis factor (TNF) antagonists on lymphoma risk and characteristics is unclear. Objective: To assess expected rates and relative risks of haematopoietic malignancies, especially those associated with TNF antagonists, in large population based cohorts of patients with RA. Methods: A population based cohort study was performed of patients with RA ( one prevalent cohort (n = 53 067), one incident cohort ( n = 3703), and one TNF antagonist treated cohort 1999 through 2003 ( n = 4160)), who were linked with the Swedish Cancer Register. Additionally, the lymphoma specimens for the 12 lymphomas occurring in patients with RA exposed to TNF antagonists in Sweden 1999 through 2004 were reviewed. Results: Study of almost 500 observed haematopoietic malignancies showed that prevalent and incident patients with RA were at increased risk of lymphoma ( SIR = 1.9 and 2.0, respectively) and leukaemia ( SIR = 2.1 and 2.2, respectively) but not of myeloma. Patients with RA treated with TNF antagonists had a tripled lymphoma risk ( SIR = 2.9) compared with the general population. After adjustment for sex, age, and disease duration, the lymphoma risk after exposure to TNF antagonists was no higher than in the other RA cohorts. Lymphomas associated with TNF antagonists had characteristics similar to those of other RA lymphomas. Conclusion: Overall, patients with RA are at equally increased risks for lymphomas and leukaemias. Patients with RA treated with TNF antagonists did not have higher lymphoma risks than other patients with RA. Prolonged observation is needed to determine the long term effects of TNF antagonists on lymphoma risk.},
  author       = {Askling, J and Fored, CM and Baecklund, E and Brandt, L and Backlin, C and Ekbom, A and Sundstrom, C and Bertilsson, L and Coster, L and Geborek, Pierre and Jacobsson, LT and Lindblad, S and Lysholm, J and Rantapaa-Dahlqvist, S and Saxne, Tore and Klareskog, L and Feltelius, N},
  issn         = {1468-2060},
  language     = {eng},
  number       = {10},
  pages        = {1414--1420},
  publisher    = {British Medical Association},
  series       = {Annals of the Rheumatic Diseases},
  title        = {Haematopoietic malignancies in rheumatoid arthritis: lymphoma risk and characteristics after exposure to tumour necrosis factor antagonists},
  url          = {http://dx.doi.org/10.1136/ard.2004.033241},
  volume       = {64},
  year         = {2005},
}