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Cancer risk in patients with rheumatoid arthritis treated with anti-tumor necrosis factor [alpha] therapies: Does the risk change with the time since start of treatment?
Arthritis & Rheumatism, 11/05/09

Askling J et al. – The goal of this study was to determine the short-term and medium-term risks of cancer in patients receiving anti-tumor necrosis factor (anti-TNF) therapies that have proven effective in the treatment of chronic inflammatory conditions. During the first 6 years after the start of anti-TNF therapy in routine care, no overall elevation of cancer risk and no increase with followup time were observed.

Methods

Identified and analyzed for cancer occurrence a national cohort of 6,366 patients with RA who first started anti-TNF therapy between January 1999 and July 2006
Used national biologics-naive RA cohort (n = 61,160), a cohort of RA patients newly starting methotrexate (n = 5,989), a cohort of RA patients newly starting disease-modifying antirheumatic drug combination therapy (n = 1,838), and general population
RRs estimated using Cox regression analyses, examining overall RR as well as RR by time since first start of anti-TNF therapy, by duration of active anti-TNF therapy, and by anti-TNF agent received

Results

During 25,693 person-years of followup in 6,366 patients newly starting anti-TNF, 240 first cancers occurred, yielding an RR of 1.00 (95% confidence interval 0.86-1.15) versus biologics-naive RA cohort, and similar RRs versus other 2 RA comparators
RRs did not increase with increasing time since the start of anti-TNF therapy, nor with cumulative duration of active anti-TNF therapy

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