RESEARCH - The effect of MTX and anti-TNF therapy on the risk of lymphoma in RA in 19,562 patients during 89,710 person-years of observation

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Arthritis Rheum. 2007 May;56(5):1433-9.

The effect of methotrexate and anti-tumor necrosis factor therapy on

the risk of lymphoma in rheumatoid arthritis in 19,562 patients during

89,710 person-years of observation.

Wolfe F, Michaud K.

National Data Bank for Rheumatic Diseases, Wichita, KS 67214, USA.

OBJECTIVE: To ascertain the relationship between anti-tumor necrosis

factor (anti-TNF) therapy, methotrexate (MTX), and the risk of

lymphoma in patients with rheumatoid arthritis (RA). This report

updates our previous report during 29,314 person-years of followup.

METHODS: Participants in the National Data Bank for Rheumatic Diseases

(NDB) longitudinal study of long-term outcomes of RA completed

semiannual questionnaires from 1998 through 2005, during 89,710

person-years of followup. Lymphoma reports were validated by medical

records. The association between lymphoma and treatment was

investigated using conditional logistic regression, adjusted for

severity and demographic covariates. RESULTS: Of the 19,591

participants, 55.3% received biologic agents and 68.0% received MTX

while enrolled in the NDB. The lymphoma incidence rate was 105.9 (95%

confidence interval [95% CI] 86.6-129.5) per 100,000 person-years of

exposure. Compared with the SEER (Surveillance, Epidemiology, and

End-Results) lymphoma database, the standardized incidence ratio was

1.8 (95% CI 1.5-2.2). The odds ratio (OR) for lymphoma in patients who

received anti-TNF therapy compared with patients who did not receive

anti-TNF therapy was 1.0 (95% CI 0.6-1.8 [P = 0.875]). The OR for

lymphoma in patients who received anti-TNF plus MTX therapy compared

with patients who received MTX treatment alone was 1.1 (95% CI 0.6-2.0

[P = 0.710]). Infliximab and etanercept considered individually also

were not associated with a risk of lymphoma.

CONCLUSION: In a study of lymphoma in 19,591 RA patients over 89,710

person-years of followup, which included exposure to anti-TNF therapy

in 10,815 patients, we did not observe evidence for an increase in the

incidence of lymphoma among patients who received anti-TNF therapy.

PMID: 17469100

http://www.ncbi.nlm.nih.gov/pubmed/17469100

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