Rheumatoid arthritis (RA) patients have an increased tumor risk compared with the general population. TNF antagonists do not increase the overall cancer risk in adults with rheumatoid arthritis. At least five recent meta-analyses including clinical trials and data from registries have failed to show an increased risk of malignancy in RA patients treated with TNF antagonists. In contrast, a previous meta-analysis showed a 3-fold increase in the rate of malignancies compared with placebo. This latter study did not adjust for exposure time despite a larger number of dropouts in the placebo group during the randomized controlled phase. After correction for follow-up time, the increased risk could not be demonstrated. Further analysis of other reports shows that type of inhibitor and duration of treatment do not changed the overall risk. Also, there is no increase in specific cancers. The increased risk of relapse or second primary cancers in patients treated with TNF antagonists is disputed. In clinical trials, patients with a malignancy before the trial are commonly excluded. In reports, no conclusive information was found
The risk of lymphoma is also higher in RA patients than in the general population. One risk factor associated with lymphoma in RA patients is high inflammatory activity. These patients are more likely to be treated with TNF antagonists and would be at an increased risk of lymphoma. In a large RA study of patients with an exposure of 89,710 person-years, the OR for lymphoma in patients treated with TNF antagonists compared with non-exposed patients was 1.0 (95% CI 0.6-1.8). In another study, RA patients treated with TNF antagonists were at increased risk of lymphoma compared with the general population. After adjustment for age, sex, and disease duration, the risk of lymphoma in patients treated with TNF antagonists was not higher than RA patients non-exposed to with TNF antagonists. In summary, the risk of lung tumor and lymphoma is increased in RA patients compared to the general population, but treatment with TNF antagonists does not increase further this risk
Disclosure of Interest J. Gomez-Reino Grant/Research support from: Pfizer, MSD, Roche, Consultant for: Abbott, BMS, Pfizer, MSD, Roche, UCB, Conflict with: Abbott, BMS, Pfizer, MSD, Roche, UCB
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