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Anti-TNF-a therapy not associated with malignancy in RA, PA, ankylosing spondylitis patients

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Patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis who received anti-tumor necrosis factor-alpha therapy were not at increased risk for solid or hematological malignancies, according to a study presented at the annual congress of the European League Against Rheumatism in Madrid.

Researchers conducted a 7-year observational retrospective case-control study that included 399 patients with rheumatoid arthritis (RA; n=202), psoriatic arthritis (PA; n=147) or ankylosing spondylitis (AS; n=50).

Anti-tumor necrosis factor-alpha (anti-TNF-a) therapies — etanercept, adalimumab or infliximab — plus disease-modifying antirheumatic drugs (DMARDs) were assigned to 279 patients. The remainder was assigned DMARDs alone. Two hundred fifty-six patients, balanced equally between treatment cohorts, also were assigned low-dose corticosteroids (<7.5 mg/day).

To date, 14 (3.5%) malignancies, including four lymphomas, were observed. Researchers conducted univariate and multivariate analyses to examine associations between cancer/lymphoma incidence and the following variables: age, sex, smoking, disease duration, autoantibody positivity, erythrocyte sedimentation rate and C-reactive protein levels. They also factored in comorbidities, including diabetes, COPD/asthma and hypertension.

While no increased risk for cancer was observed among patients based on sex (OR=0.56, 95% CI; 0.23-1.16 for women; OR=1.08, 95% CI; 0.47-2.12 for men), lymphoma risk was significantly greater among women (OR=7.69; 95% CI, 1.59-22.48) compared with men (OR=4.76; 95% CI, 0.12-26.53).

Under multivariate analysis, patients who received anti-TNF-a and DMARD therapy showed no associations with cancer (OR=3.11, 95% CI; 0.67-14.41) or lymphoma (univariate analysis: OR=1.29, 95% CI; 0.13-12.56) compared with patients treated with DMARDs alone.

“The risk of lymphoma seems higher among female patients, but anti-TNF-a therapy in RA, PA and AS patients seems not to be associated with an increased risk of solid or hematological malignancies,” the researchers concluded.

For more information:

Fantò M. FRI0195: Treatment with Anti-TNF Biologics in Patients with Rheumatoid Arthritis, Psoriatic Arthritis and Anklylosing Spondylitis Does Not Increase the Risk of Malignancy. Presented at: EULAR 2013; June 12-15, Madrid.