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. 2012 Jun;71(6):869-74.
doi: 10.1136/annrheumdis-2011-200622. Epub 2012 Jan 12.

The influence of anti-TNF therapy upon incidence of keratinocyte skin cancer in patients with rheumatoid arthritis: longitudinal results from the British Society for Rheumatology Biologics Register

Louise K Mercer  1 , Adele C Green, James B Galloway, Rebecca Davies, Mark Lunt, William G Dixon, Kath D Watson; British Society for Rheumatology Biologics Register Control Centre Consortium; Deborah P M Symmons, Kimme L Hyrich; British Society for Rheumatology Biologics Register
Collaborators, Affiliations
Free PMC article

The influence of anti-TNF therapy upon incidence of keratinocyte skin cancer in patients with rheumatoid arthritis: longitudinal results from the British Society for Rheumatology Biologics Register

Louise K Mercer et al. Ann Rheum Dis. 2012 Jun.
Free PMC article

Abstract

Objectives: To compare the risk of keratinoctye skin cancer (basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)) in patients treated for rheumatoid arthritis (RA) compared with the general population, and to determine whether anti-tumour necrosis factor (TNF) therapy exacerbates this risk.

Methods: Patients with RA enrolled in the British Society for Rheumatology Biologics Register, a prospective national cohort established in 2001 to monitor the safety of anti-TNF, were followed until 2008. 11 881 patients treated with anti-TNF were compared with 3629 patients receiving non-biological disease-modifying antirheumatic drugs (nbDMARD). Standardised incidence ratios (SIR) were calculated for each cohort and rates between cohorts were compared using Cox proportional HR, adjusted using inverse probability of treatment weighting.

Results: SIR for skin cancer was increased in both cohorts compared with the English population: SIR 1.72 (95% CI 1.43 to 2.04) anti-TNF; 1.83 (95% CI 1.30 to 2.50) nbDMARD only. In patients without previous skin cancer, BCC incidence per 100 000 patient-years was 342 (95% CI 290 to 402) after anti-TNF and 407 (95% CI 288 to 558) after nbDMARD. HR after anti-TNF adjusted for treatment weighting was 0.95 (95% CI 0.53 to 1.71). SCC incidence per 100 000 patient-years: anti-TNF 53 (95% CI 33 to 79); nbDMARD 43 (95% CI 12 to 110); adjusted HR 1.16 (95% CI 0.35 to 3.84).

Conclusions: Skin cancers were increased among treated patients with RA. No evidence was found that anti-TNF therapy exacerbates the risk of BCC or SCC but this cannot be excluded. Patients with RA should use sun protection and be monitored for skin cancer.

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Conflict of interest statement

Competing interests None.

Figures

Figure 1
Figure 1
Flowchart showing selection of patients for the analysis. nbDMARD, non-biological disease-modifying antirheumatic drug; RA, rheumatoid arthritis; TNF, tumour necrosis factor.
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