Background Systemic inflammatory rheumatic diseases, may increase the risk of malignancy, and in particular of lymphoproliferative disorders1. If anti-TNFα therapy is associated with this risk is still controversial2,3.
Objectives The aim of this study was to compare the risk of malignancy in 399 patients with Rheumatoid Arthritis (RA), Psoriatic Arthritis (PA) and Ankylosing Spondilylitis (AS), treated with either TNFα inhibitors plus DMARDs or DMARDs alone.
Methods An observational retrospective case-control study in 202 RA, 147 PA and 50 AS patients, 279 (69.9%) of whom under anti-TNFα therapy (etanercept, adalimumab, infliximab) plus DMARDs and 119 (30.1%) under DMARDs alone, has been performed in the period 2004-2011. Two hundred-fiftysix (64.2%) patients, balanced between the two treatment groups, also received low-dose (<7,5 mg/day) corticosteroids (CCS). Fourteen (3.5%) malignancies, four of which lymphomas, have been observed. In order to analyze possible association between different variables and cancer/lymphoma development, univariate and multivariate analysis taking into account age, sex, smoking habits, disease duration, autoantibody (rheumatoid factor and anti-cyclic citrullinated peptide) positivity, erythrocyte sedimentation rate and C-reactive protein levels as well as different therapies and comorbidities (diabetes, COPD/asthma, hypertension) have been performed.
Results No increased risk of cancer was found in the study group (OR 0.56, 95% CI: 0.23-1.16 for female sex; OR 1.08, 95% CI: 0.47-2.12 for males). Otherwise, the risk of lymphoma seems significantly higher among females (7.69, 95% CI: 1.59-22.48), but not among males (OR 4.76, 95% CI: 0.12-26.53). No association between cancer (multivariate analysis: OR 3.11, 95% CI 0.67-14.41) or lymphoma (univariate analysis: OR 1.29, 95% CI 0.13-12.56) and anti-TNFα inhibitor therapy has been observed among patients treated with TNFα inhibitors, compared with patients treated with DMARDs alone.
Conclusions Overall, the risk of lymphoma seems higher among female patients, but anti-TNFα therapy in RA, PA, AS patients seems not to be associated with an increased risk of solid or haematological malignancies.
Turesson C, Matteson EL. Malignancy as a comorbidity in rheumatic diseases. Rheumatology (Oxford). 2013 Jan;52(1):5-14
Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V. Anti-TNFantibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 2006;295:2275-85
Lopez-Olivo MA, Tayar JH, Martinez-Lopez JA, Pollono EN, Cueto JP, Gonzales-Crespo MR, Fulton S, Suarez-Almazor ME. Risk of malignancies in patients with rheumatoid arthritis treated with biologic therapy: a meta-analysis. JAMA 2012;308:898-908
Disclosure of Interest None Declared