RESEARCH - TNF-alpha antagonist use and cancer in patients with RA

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Arthritis Rheum. 2006 Aug 31;54(9):2757-2764 [Epub ahead of print]

Tumor necrosis factor alpha antagonist use and cancer in patients with

rheumatoid arthritis.

Setoguchi S, DH, Weinblatt ME, Katz JN, Avorn J, Glynn RJ, Cook EF,

Carney G, Schneeweiss S.

Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

OBJECTIVE: Concerns persist about a possible association between tumor

necrosis factor alpha (TNFalpha) antagonist treatment and development of

cancers in patients with rheumatoid arthritis (RA). This study was

undertaken to estimate the association between treatment with biologic

disease-modifying antirheumatic drugs (DMARDs) and development of cancer in

patients with RA. METHODS: We conducted a cohort study pooling

administrative databases from 2 US states and 1 Canadian province. A cohort

of patients who had received a diagnosis of RA on >/=1 occasion and had been

prescribed DMARDs was identified. We categorized patients with a

prescription for a biologic DMARD as biologic DMARD users, and those with a

prescription for methotrexate (MTX) but no biologic DMARD as MTX users. We

used time-varying propensity scores to adjust for the large number of

possible confounders and stratified proportional hazards regression to

estimate the effects of biologic DMARDs on cancer. The primary end points

were hematologic malignancies (lymphoma, multiple myeloma, and leukemia) and

common solid tumors (colorectal, lung, stomach, breast, prostate, uterine,

ovarian, urinary tract/bladder, and melanoma). RESULTS: The pooled cohort

included 1,152 biologic DMARD users and 7,306 MTX users. We identified 11

hematologic malignancies and 46 solid tumors during 2,940 person-years of

biologic DMARD use, and 88 hematologic malignancies and 558 solid tumors

during 30,300 person-years of MTX use. Comparing biologic DMARD users with

MTX users, the propensity score-adjusted pooled hazard ratio was 1.37 (95%

confidence interval 0.71-2.65) for hematologic malignancies and 0.91 (95%

confidence interval 0.65-1.26) for solid tumors.

CONCLUSION: Our results indicate that users of biologic agents are unlikely

to have a substantial increase in the risk of hematologic malignancies and

solid tumors as compared with MTX users. Despite the use of large combined

data sets, studying the effect of an infrequent exposure (biologic DMARDs)

on rare diseases (hematologic malignancies) remains a challenge.

PMID: 16947774

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6947774

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