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Observational Study
. 2017 Mar;76(3):497-503.
doi: 10.1136/annrheumdis-2016-209389. Epub 2016 Aug 8.

Risk of lymphoma in patients exposed to antitumour necrosis factor therapy: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Louise K Mercer  1 , James B Galloway  2 , Mark Lunt  1 , Rebecca Davies  1 , Audrey L S Low  1 , William G Dixon  1   3 , Kath D Watson  1 ; BSRBR Control Centre Consortium; Deborah P M Symmons  1   3 , Kimme L Hyrich  1   3
Collaborators, Affiliations
Observational Study

Risk of lymphoma in patients exposed to antitumour necrosis factor therapy: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Louise K Mercer et al. Ann Rheum Dis. 2017 Mar.

Abstract

Objectives: Patients with rheumatoid arthritis (RA) are at increased risk of lymphoma compared with the general population. There are concerns that tumour necrosis factor inhibitors (TNFi) may exacerbate this risk. However, since the excess risk of lymphoma in RA is related to the cumulative burden of inflammation, TNFi may conversely reduce the risk of lymphoma by decreasing the burden of inflammation. The aim of this study was to compare the risk of lymphoma in subjects with RA treated with TNFi with those treated with non-biological therapy.

Methods: Subjects diagnosed by a rheumatologist with RA enrolled in the British Society for Rheumatology Rheumatoid Arthritis Register (BSRBR-RA), a prospective cohort study, were followed until first lymphoma, death or until 30 November 2013. Rates of lymphoma in the TNFi and non-biological-treated cohorts were compared using Cox regression.

Results: 11 931 TNFi-treated patients were compared with 3367 biological-naive patients. 84 lymphomas (88 (95% CI 70 to 109) per 100 000 person-years) were reported in the TNFi cohort and 30 lymphomas (154 (95% CI 104 to 220)) in the biological-naive cohort. After adjusting for differences in baseline characteristics, there was no difference in the risk of lymphoma for the TNFi versus the biological-naive group: HR 1.00 (95% CI 0.56 to 1.80). No risk differences were observed for individual TNFi.

Conclusions: In medium-term follow-up, there is no evidence that tumour necrosis factor inhibition influences the risk of lymphoma over the background risk in subjects with RA.

Keywords: Anti-TNF; Epidemiology; Rheumatoid Arthritis.

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Conflict of interest statement

Competing interests: KH has received honoraria from AbbVie and Pfizer.

Figures

Figure 1
Figure 1
Selection of participants for the analysis. DAS28, 28-joint Disease Activity Score; LPM, lymphoproliferative malignancy; MPM, myeloproliferative malignancy; RA, rheumatoid arthritis; TNF, tumour necrosis factor; TNFi, tumour necrosis factor inhibitors.
See this image and copyright information in PMC

Comment in

References

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