RESEARCH - The effect of MTX and anti-TNF therapy on the risk of lymphoma in RA in 19,562 patients

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Arthritis & Rheumatism

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Arthritis Care & Research

Volume 56 Issue 5, Pages 1433 - 1439

Published Online: 27 Apr 2007

Research Article

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

Frederick Wolfe 1 *, Kaleb Michaud 2

1National Data Bank for Rheumatic Diseases, and University of Kansas

School of Medicine, Wichita

2National Data Bank for Rheumatic Diseases, Wichita, Kansas and

University of Nebraska Medical Center, Omaha

Abstract

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.

http://www3.interscience.wiley.com/journal/114229141/abstract?CRETRY=1 & SRETRY=0

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