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Patients with RA may not have increased risk for lymphoma with TNFi use
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Patients with rheumatoid arthritis may not have an increased risk for lymphoma after being treated with tumor necrosis factor inhibitors compared to patients with rheumatoid arthritis treated with other agents, according to a recently published study.
Data from 11,931 patients with rheumatoid arthritis (RA) enrolled in the British Society for Rheumatology Rheumatoid Arthritis Register (BSRBR-RA) and treated with tumor necrosis factor inhibitors (TNFi) were analyzed and compared to 3,367 patients with RA who were naïve to biologics. Patient data included smoking status, disease activity, current and prior use of disease-modifying antirheumatic drugs (DMARDs), comorbidities, corticosteroid use and demographics. Treatment changes were reported on a 6-month basis for 3 years and once a year thereafter. The first 6 months of patient history was not included to eliminate the risk of including preexisting lymphoma.
Patients who received TNFi were more likely to be women, to be younger, have severe disease activity and had higher exposure to corticosteroids. Patients prescribed conventional DMARDs were followed for an average of 6.5 years, while patients who received TNFi were followed for 8.6 years.
During the follow-up period, 114 cases of lymphoma were diagnosed. Of these, 30 cases in the conventional DMARD group with 19,473 person-years and 84 were in the TNFi group with 95,126 person-years.
Unadjusted models showed the hazard ratio for lymphoma for the TNFi group was 0.61, while adjusted models showed no difference in risks between the two groups. However, age and male gender were associated with a higher risk for lymphoma.
“In conclusion, this study has ruled out an important risk of lymphoma in patients with RA exposed to TNFi over the background risk associated with RA for up to 5 years after treatment initiation,” the researchers wrote. “This is consistent with other published data and the biological expectation that disease activity is the primary driver for lymphoma in RA.” - by Shirley Pulawski
Disclosures: The researchers report funding from UK pharmaceutical companies, presently AbbVie (previously Abbott Laboratories); Merck; Pfizer; Roche; Union Chimique Belge Pharma Ltd. and Swedish Orphan Biovitrum AB. Please see the full study for a list of all other authors’ relevant financial disclosures.
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