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Cancer risk in patients with spondyloarthritis treated with TNF inhibitors: a collaborative study from the ARTIS and DANBIO registers
  1. Karin Hellgren1,2,
  2. Lene Dreyer3,4,
  3. Elizabeth V Arkema2,
  4. Bente Glintborg3,4,
  5. Lennart T H Jacobsson5,
  6. Lars-Erik Kristensen4,6,
  7. Nils Feltelius1,7,
  8. Merete Lund Hetland8,9,
  9. Johan Askling1,2
  10. For the ARTIS Study Group, For the DANBIO Study Group
    1. 1Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
    2. 2Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
    3. 3Department of Rheumatology, Herlev and Gentofte University Hospital, Hellerup, Denmark
    4. 4The Parker Institute, Bispebjerg and Frederiksberg, University of Copenhagen, Copenhagen, Denmark
    5. 5Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
    6. 6Department of Rheumatology, Lund University Hospital, Lund, Sweden
    7. 7Swedish Medical Products Agency, Uppsala, Sweden
    8. 8DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
    9. 9Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
    1. Correspondence to Dr Karin Hellgren, Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet at Karolinska University Hospital, 171 76 Stockholm, Sweden; karin.hellgren{at}karolinska.se

    Abstract

    Background Safety data on cancer risks following tumour necrosis factor α inhibitors (TNFi) in patients with spondyloarthritis (SpA) (here defined as ankylosing spondylitis (AS), undifferentiated spondarthropaties (SpA UNS), psoriatic arthritis (PsA)) are scarce. Our objective was to assess risks for cancer overall and for common subtypes in patients with SpA treated with TNFi compared with TNFi-naïve patients with SpA and to the general population.

    Methods From the Swedish (Anti-Rheumatic Therapy in Sweden (ARTIS)) and Danish (DANBIO) biologics registers, we assembled 8703 (ARTIS=5448, DANBIO=3255) patients with SpA initiating a first TNFi 2001–2011. From the Swedish National Patient and Population Registers we assembled a TNFi-naïve SpA cohort (n=28,164) and a Swedish age-matched and sex-matched general population comparator cohort (n=131 687). We identified incident cancers by linkage with the nationwide Swedish and Danish Cancer Registers 2001–2011, and calculated age-standardised and sex-standardised incidence ratios as measures of relative risk (RR).

    Results Based on 1188 cancers among the TNFi-naïve patients with SpA, RR of cancer overall was 1.1 (95% CI 1.0 to 1.2). Based on 147 cancers among TNFi initiators with SpA, RR versus TNFi-naïve was 0.8 (95% CI 0.7 to 1.0) and results were similar for AS and PsA when analysed separately. Site-specific cancer RRs: prostate 0.5 (95% CI 0.3 to 0.8), lung 0.6 (95% CI 0.3 to 1.3), colorectal 1.0 (95% CI 0.5 to 2.0), breast 1.3 (95% CI 0.9 to 2.0), lymphoma 0.8 (95% CI 0.4 to 1.8) and melanoma 1.4 (95% CI 0.7 to 2.6).

    Conclusions In patients with SpA, treatment with TNFi was not associated with increased risks of cancer, neither overall nor for the six most common cancer types.

    • Anti-TNF
    • Ankylosing Spondylitis
    • Psoriatic Arthritis
    • Spondyloarthritis
    • Outcomes research

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