Table 2

Rates of malignancies in TNFi treated patients

ReferenceSourceIndicationNo of patients (patient-years)Incidence rate per 1000 patient-years (95% CI)Risk estimate (95% CI)Standardised incidence ratio (95% CI)
All-site malignancies
 Watson et al (2006)51BSRBRRA9999 (19 070)8.6 (7.4 to 10.0)0.7 (0.4 to 1.2)*NR
 Greenberg et al (2007)19CORRONARA4651 (8690)7.48 (NR)1.05 (0.73 to 1.51)*NR
 Wolfe and Michaud (2007)31NDBRDRA5257 (NR)NR1.0 (0.8 to 1.2)1.0 (1.0 to 1.1)§
 Abasolo et al (2008)20BIOBADASERRA4529 (11 758)6.0 (4.7 to 7.5)0.92 (0.41 to 2.04)*NR
 Askling et al (2009)15ARTISRA6366 (25 693)9.34 (8.19 to 10.60)1.00 (0.87 to 1.17)0.9 (0.7 to 1.2)**
 Du Pan et al (2009)14SCQM-RARA2364 (3867)3.88 (NR)NRNR
 Gibofsky et al (2009)18RADIUSRA2206 (3509)7 (5 to 11)0.6 (0.3 to 1.6)§NR
 Pallavicini et al (2010)24LORHENRA1064 (2069)8.7 (4.68 to 12.72)NR0.94 (0.55 to 1.48)††
1.09 (0.64 to 1.72)‡‡
 Strangfeld et al (2010)17§§RABBITRA3346 (12 198)5.1 (3.7 to 6.9)0.70 (0.44 to 1.12)¶¶0.75 (0.54 to 1.01)
Haematopoietic malignancies
 Askling et al (2005)41ARTISRA4160 (9715)1.13 (NR)NR2.1 (1.1 to 3.8)
 Greenberg et al (2007)19CORRONARA4651 (8690)0.69 (NR)0.76 (0.26 to 2.29)*NR
 Pallavicini et al (2010)24LOHRENRA1064 (2069)NRNR4.08 (1.32 to 9.53)††
4.07 (1.31 to 9.49)‡‡
Leukaemia
 Askling et al (2005)41***ARTISRA4160 (9715)0.21 (NR)NR2.0 (0.2 to 7.3)
 Wolfe and Michaud (2007)31NDBRDRA5257 (NR)NR1.2 (0.5 to 3.1)NR
Lymphoma
 Wolfe and Michaud (2004)21NDBRDRA8614 (10 012)1.4 (NR)NR2.9 (1.7 to 4.9)
 Greenberg et al (2007)19CORRONARA4651 (8690)0.58 (NR)0.74 (0.23 to 2.45)*NR
 Wolfe and Michaud (2007)22NDBRDRA10 834 (NR)NR1.0 (0.6 to 1.8)NR
 Askling et al (2009)23ARTISRA6604 (29 981)0.96 (0.63 to 1.41)1.35 (0.82 to 2.11)2.72 (1.82 to 4.08)†††
 Pallavicini et al (2010)24LOHRENRA1064 (2069)3.38 (0.88 to 5.89)NR5.99 (1.61 to 15.35)††
4.98 (1.34 to 12.74)‡‡
 Mariette et al (2010)25RATIOAllNR (57 711)0.42 (0.07 to 0.78)NR2.4 (1.7 to 3.2)
RA‡‡‡NRNRNR2.3 (1.6 to 3.3)
Prior malignancies
 Dixon (2010)16BSRBRRA177 (NR)25.3 (13.4 to 43.2)§§§0.58 (0.23 to 1.43)*NR
 Strangfeld et al (2010)17¶¶RABBITRA72 (198)45.5 (20.8 to 86.3)1.4 (0.5 to 5.5)*NR
Melanoma
 Greenberg et al (2007)19CORRONARA4651 (8690)0.35 (NR)NRNA§§§§
 Wolfe and Michaud (2007)31NDBRDRA6238 (NR)NR2.3 (0.9 to 5.4)****NR
 Askling (2009)28ARTISRA6604 (NR)NR1.7 (1.0 to 2.9)NR
NMSC
 Greenberg et al (2007)19CORRONARA4651 (8690)2.3 (NR)1.83 (0.85 to 3.93)*NR
 Wolfe and Michaud (2007)31NDBRDRA5257 (NR)NR1.5 (1.2 to 1.8)NR
1394 (NR)§§§NR2.3 (0.9 to 5.4)††††
 Mercer et al (2009)30‡‡‡‡BSRBRRA11 757 (NR)3.5 (2.9 to 4.1)Crude 1.0 (0.6 to 1.6)¶¶NR
Adj 1.7 (0.9 to 3.4)
 Askling (2009)28ARTISRA6604 (NR)NR1.2 (0.8 to 2.0)¶¶¶¶NR
  • * Adjusted incidence rate ratio.

  • Includes Anakinra data.

  • OR.

  • § Excludes NMSC.

  • RR.

  • ** Solid malignancies.

  • †† Compared with general population data in the Milan Cancer report.

  • ‡‡ Compared with general population data in the Varese Cancer Registry database.

  • §§ Patients without previous malignancy.

  • ¶¶ HR.

  • *** Excluding chronic lymphocytic leukaemia.

  • ††† Against general population.

  • ‡‡‡ RA data included in the analyses.

  • §§§ Against DMARD population.

  • ¶¶¶ Patients with previous malignancies only.

  • **** 3+ years since entry into registry.

  • †††† Melanoma cases.

  • ‡‡‡‡ Patients with no previous NMSC.

  • §§§§ Three occurrences in TNFi cohort but zero occurrences in DMARD cohort.

  • ¶¶¶¶ Squamous cell skin cancer.

  • DMARD, disease-modifying antirheumatic drug; NMSC, non-melanoma skin cancer; NR, not reported; RA, rheumatoid arthritis; TNFi, tumour necrosis factor inhibitor.