Risk of skin cancer for anti-TNF therapy in patients with RA without previous history of skin cancer
| BCC | SCC | ||||||
|---|---|---|---|---|---|---|---|
| nbDMARD | Anti-TNF | Etanercept | Infliximab | Adalimumab | nbDMARD | Anti-TNF | |
| Number ever exposed to drug during follow-up | 3523 | 11 704 | 5086 | 3663 | 5035 | 3523 | 11 704 |
| Exposure time (years) | 9342 | 43 798 | 19 108 | 11 700 | 12 991 | 9342 | 43 798 |
| Median exposure time per subject (years) | 2.65 | 4.01 | 3.70 | 2.70 | 2.05 | 2.65 | 4.01 |
| Patients with cancer | 34 | 121 | 47 | 45 | 29 | 4 | 19 |
| Cancers | 38 | 150 | 57 | 59 | 34 | 4 | 23 |
| Incident rate/100 000 patient-years (95% CI) | 407 (288 to 558) | 342 (290 to 402) | 298 (226 to 387) | 504 (384 to 650) | 262 (181 to 366) | 43 (12 to 110) | 53 (33 to 79) |
| Unadjusted HR (95% CI) | Ref | 0.84 (0.58 to 1.20) | 0.71 (0.47 to 1.08) | 1.25 (0.83 to 1.89) | 0.64 (0.40 to 1.02) | Ref | 0.93 (0.32 to 2.76) |
| Age and gender HR (95% CI) | Ref | 1.20 (0.83 to 1.73) | 1.07 (0.70 to 1.63) | 1.73 (1.14 to 2.62) | 0.89 (0.56 to 1.42) | Ref | 1.79 (0.59 to 5.41) |
| aHR (95% CI) | Ref | 0.95 (0.53 to 1.71) | 0.80 (0.44 to 1.47) | 1.47 (0.76 to 2.85) | 0.73 (0.37 to 1.46) | Ref | 1.16 (0.35 to 3.84) |
| First cancer per subject incident rate/100 000 patient-years (95% CI) | 364 (252 to 509) | 276 (229 to 330) | 246 (181 to 328) | 376 (273 to 505) | 231 (156 to 330) | ||
| First cancer per subject aHR (95% CI) | Ref | 0.81 (0.45 to 1.48) | 0.69 (0.37 to 1.29) | 1.15 (0.60 to 2.21) | 0.68 (0.33 to 1.38) | ||
| Excluding first year of follow-up aHR (95% CI) | Ref | 1.18 (0.60 to 2.32) | 1.05 (0.52 to 2.14) | 1.70 (0.81 to 3.58) | 0.91 (0.41 to 2.01) | ||
| On drug analysis aHR (95% CI) | Ref | 0.88 (0.48 to 1.60) | 0.68 (0.36 to 1.29) | 1.24 (0.63 to 2.46) | 0.68 (0.32 to 1.42) | Ref | 0.96 (0.28 to 3.32) |
aHR, hazard ratio adjusted for inverse probability of treatment weighting; BCC,basal cell carcinoma; nbDMARD, non-biological disease-modifying antirheumatic drug; RA, rheumatoid arthritis; Ref, referent; SCC, squamous cell carcinoma; TNF, tumour necrosis factor.