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Patients with rheumatoid arthritis (RA) are at increased risk of lymphoma,1–4 and anti-tumour necrosis factor (TNF) agents may further increase this risk.5 6 We conducted a retrospective cohort study of this question using the computerised data of Kaiser Permanente (KP; http://www.kaiserpermanente.org/). We defined a “severe RA cohort” of potential candidates for anti-TNF therapy as those aged 18 years and older from 1996–2002 who received at least two diagnoses of RA and were prescribed a disease-modifying antirheumatic drug (DMARD) after receiving methotrexate (n = 3982). Patients who had a previous history of anti-TNF agent were excluded. Follow-up began with the prescription of the first DMARD after methotrexate …
Funding: This research was supported by a contract from Wyeth Research.
Competing interests: This study was sponsored by Wyeth (Madison, New Jersey, USA), which produces and markets etanercept (Enbrel). Kaiser Permanente investigators had control over publication. One author (DM) is employed by Wyeth and owns company stock.
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