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We thank Nocturne et al1 for their interest and comments on our recent paper, which looked at lymphoma risk over the medium term in a cohort of patients receiving tumour necrosis factor inhibitor (TNFi).1 Overall we found no statistically significant difference in the risk compared with conventional standard disease-modifying antirheumatic drugs (csDMARDs) either for all TNFi exposures combined or when each TNFi was analysed separately in comparison to csDMARDs, using a number of different models to categorise treatment exposure.
We agree that lymphoma is a heterogeneous group of malignancies and that the spectrum of lymphomas seen in people with rheumatoid arthritis (RA) is different from that in the general population, with an over-representation of inflammation-driven diffuse large B-cell lymphoma (DLBCL). Therefore, understanding whether TNFi treatment is associated with an increase in the risk …
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