Etanercept therapy in rheumatoid arthritis and the risk of malignancies: a systematic review and individual patient data meta-analysis of randomised controlled trials
- 1Division of Rheumatology and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- 2Department of Health Sciences, University of Leicester, Leicester, UK
- 3Global Safety Surveillance and Epidemiology, Wyeth Research, Collegeville, Pennsylvania, USA
- Dr T Bongartz, Division of Rheumatology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA;
- Accepted 29 October 2008
- Published Online First 19 November 2008
Purpose: Tumour necrosis factor (TNF) plays an important role in inflammation and may affect tumour growth control. To assess the risk of malignancy with etanercept, a fusion protein that inhibits TNF action, a meta-analysis was performed using individual patient data from randomised controlled trials (RCT) in patients with rheumatoid arthritis (RA).
Methods: A search was conducted of bibliographic databases, abstracts from annual meetings and any unpublished studies on file with manufacturers of etanercept to December 2006. Only RCT of etanercept used for 12 weeks or more in patients with RA were included. Nine trials met the inclusion criteria. To adjudicate endpoints, the case narratives of potential cases were reviewed. Patient-level data were extracted from the clinical trials databases.
Results: The nine trials included 3316 patients, 2244 who received etanercept (contributing 2484 person-years of follow-up) and 1072 who received control therapy (1051 person-years). Malignancies were diagnosed in 26 patients in the etanercept group (incidence rate (IR) 10.47/1000 person-years) and seven patients in the control group (IR 6.66/1000 person-years). A Cox’s proportional hazards, fixed-effect model stratified by trial yielded a hazard ratio of 1.84 (95% CI 0.79 to 4.28) for the etanercept group compared with the control group.
Conclusions: In this analysis, the point estimate of malignancy risk was higher in etanercept-treated patients, although the results were not statistically significant. The approach of obtaining individual patient data of RCT in cooperation with trial sponsors allowed important insights into the methodological advantages and challenges of sparse adverse event data meta-analysis.
Funding: This study was sponsored by Wyeth, who together with Amgen, markets etanercept in North America. Wyeth and Amgen provided data for the analysis, and Wyeth provided payment to support the costs of study preparation, data analysis and manuscript preparation.
Competing interests: Declared.
TB, FCW and AJS received grant support from Wyeth. ELM served as an investigator for Amgen, Biogen-IDEC, Centocor, Genentech, Hoffmann-LaRoche, Human Genome Sciences, Wyeth. He received grant support from Amgen, Centocor/Johnson & Johnson, Genentech, Mayo Foundation and Wyeth. He served as a consultant/on scientific advisory boards for Abbott, Amgen, BiogenIDEC and Centocor. DM is employed by Wyeth and owns stock options in the company. KRA received grant support from Wyeth. He served as a consultant to United BioSource Corporation (UBC) regarding a “mixed treatment comparison” project, which UBC has conducted for Bristol-Meyers Squibb in relation to rheumatoid arthritis.