RESEARCH - Risks of solid cancers in patients with RA and after treatment with TNF antagonists

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Published Online First: 13 April 2005. doi:10.1136/ard.2004.033993

ls of the Rheumatic Diseases 2005;64:1421-1426

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EXTENDED REPORT

Risks of solid cancers in patients with rheumatoid arthritis and after

treatment with tumour necrosis factor antagonists

J Askling 1,2, C M Fored 1, L Brandt 1, E Baecklund 3, L Bertilsson 4,

N Feltelius 2,5, L Cöster 6, P Geborek 7, L T sson 8, S Lindblad

2, J Lysholm 9, S Rantapää-Dahlqvist 10, T Saxne 7, L Klareskog 2

1 Clinical Epidemiology Unit, Department of Medicine, Karolinska

University Hospital, Stockholm, Sweden

2 Rheumatology Unit, Department of Medicine, Karolinska University

Hospital, Stockholm, Sweden

3 Department of Rheumatology, Uppsala University Hospital, Uppsala, Sweden

4 Department of Rheumatology, Sahlgrenska University Hospital,

Gothenburg, Sweden

5 Medical Products Agency, Uppsala, Sweden

6 Department of Rheumatology, Linköping University Hospital, Linköping, Sweden

7 Department of Rheumatology, Lund University Hospital, Lund, Sweden

8 Department of Rheumatology, Malmö University Hospital, Malmö, Sweden

9 Department of Rheumatology, Falu County Hospital, Falun, Sweden

10 Department of Rheumatology, University Hospital, Umeå, Sweden

ABSTRACT

Background: Existing studies of solid cancers in rheumatoid arthritis

(RA) reflect cancer morbidity up until the early 1990s in prevalent

cohorts admitted to hospital during the 1980s.

Objective: To depict the cancer pattern of contemporary patients with

RA, from updated risk data from prevalent and incident RA populations.

To understand the risk of solid cancer after tumour necrosis factor

(TNF) treatment by obtaining cancer data from cohorts treated in

routine care rather than trials.

Methods: A population based study of three RA cohorts (one prevalent,

admitted to hospital 1990–2003 (n = 53 067), one incident, diagnosed

1995–2003 (n = 3703), and one treated with TNF antagonists 1999–2003

(n = 4160)), which were linked with Swedish nationwide cancer and

census registers and followed up for cancer occurrence through 2003.

Results: With 3379 observed cancers, the prevalent RA cohort was at

marginally increased overall risk of solid cancer, with 20–50%

increased risks for smoke related cancers and +70% increased risk for

non-melanoma skin cancer, but decreased risk for breast (–20%) and

colorectal cancer (–25%). With 138 cancers, the incident RA cohort

displayed a similar cancer pattern apart from non-decreased risks for

colorectal cancer. TNF antagonist treated patients displayed solid

cancer (n = 67) risks largely similar to those of other patients with

RA.

Conclusion: The cancer pattern in patients treated with TNF

antagonists mirrors those of other contemporary as well as historic RA

cohorts. The consistent increase in smoking associated cancers in

patients with RA emphasises the potential for smoking cessation as a

cancer preventive measure in RA.

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Read the entire article here:

http://ard.bmj.com/cgi/content/full/64/10/1421

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