Risks of solid cancers in patients with rheumatoid arthritis and following treatment with tnf-antagonists

Johan Askling ^1*, Michael Fored ¹, Lena Brandt ¹, Eva Baecklund ², Lennart Bertilsson ³, Nils Feltelius ¹, Lars Cöster ⁴, Pierre Geborek ⁵, Lennart Jacobsson ¹, Staffan Lindblad ¹, Jörgen Lysholm ⁶, Solbritt Rantapää-Dahlqvist ⁷, Tore Saxne ⁵ and Lars Klareskog ¹

¹ Karolinska Institutet, Sweden
² Uppsala University Hospital, Sweden
³ Sahlgrenska University Hospital, Sweden
⁴ Linköping University Hospital, Sweden
⁵ Lund University Hospital, Sweden
⁶ Falu County Hospital, Sweden
⁷ Umeå University Hospital, Sweden

^* To whom correspondence should be addressed. E-mail: johan.askling{at}medks.ki.se.

Accepted 6 April 2005

Abstract

Background: Existing studies of solid cancers in RA reflect cancer morbidity up until the early 1990ies in prevalent cohorts hospitalized during the 1980ies. To depict the cancer-pattern of contemporary RA-patients, we thus need updated risk-data from prevalent and incident RA-populations. To understand the risk of solid cancer following TNF-antagonists we need cancer-data from cohorts treated in routine care rather than trials.

Methods: We performed a population-based study of three RA-cohorts (one prevalent, hospitalized 1990-2003 [n=53,067], one incident, diagnosed 1995-2003 [n=3,703], and one treated with TNF-antagonists 1999-2003 [n=4,160]) which were linked with Swedish nation-wide cancer- and census-registers and followed for cancer occurrence (versus general population) through 2003.

Results: With 3,379 observed cancers, the prevalent RA-cohort was at marginally elevated overall risk of solid cancer, at 20-50% increased risks for smoke-related cancers, at increased risk for non- melanoma skin cancer (+70%), but at decreased risk for breast (-20%) and colorectal cancer (-25%). With 138 cancers, incident RA displayed a similar cancer pattern apart from non-decreased risks for colorectal cancer. TNF-antagonist treated patients displayed solid cancer (n=67) risks largely similar to those of other RA- patients.

Conclusion: The cancer pattern in patients treated with TNF-antagonists so far mirror those of other contemporary as well as historic RA cohorts. The consistent increase in smoking-associated cancers in RA patients emphasizes the potential for smoke-cessation as a cancer-preventive measure in RA.

Keywords: Sweden, TNF, cancer, cohort, rheumatoid arthritis

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