Risk of cancer after treatment with TNF-I agents among patients with RA and patients with other types of arthritides
| No of cancers | |||||
|---|---|---|---|---|---|
| treated with TNF-I | TNF-I treated vs non-treated | TNF-I treated vs general population | Non-treated vs general population | ||
| Site* | Yes | No | HR† (95% CI) | SIR‡ (95% CI) | SIR‡ (95% CI) |
| All cancer sites combined | |||||
| RA patients | 152 | 128 | 1.02 (0.80 to 1.30) | 1.27 (1.08 to 1.49) | 1.25 (1.05 to 1.48) |
| All non-RA | 28 | – | 1.14 (0.79 to 1.65) | – | |
| AS | 8 | – | 0.82 (0.41 to 1.64) | – | |
| PSA | 12 | – | 1.16 (0.66 to 2.04) | – | |
| Other arthritides | 8 | – | 1.80 (0.90 to 3.60) | – | |
| Specific sites for RA patients | |||||
| Digestive organs | 23 | 18 | 1.12 (0.60 to 2.11) | 1.17 (0.78 to 1.76) | 1.01 (0.64 to 1.60) |
| Colon | 13 | 4 | 3.52 (1.11 to 11.15) | 1.61 (0.93 to 2.77) | 0.53 (0.20 to 1.40) |
| Rectum | 2 | 6 | 0.28 (0.06 to 1.43) | 0.45 (0.11 to 1.79) | 1.53 (0.69 to 3.42) |
| Pancreas | 3 | 3 | 0.72 (0.14 to 3.62) | 1.09 (0.35 to 3.38) | 1.23 (0.40 to 3.80) |
| Respiratory and intrathoracic organs | 20 | 21 | 0.83 (0.45 to 1.55) | 1.32 (0.85 to 2.05) | 1.61 (1.05 to 2.47) |
| Lung | 18 | 20 | 0.78 (0.41 to 1.49) | 1.30 (0.82 to 2.07) | 1.67 (1.08 to 2.59) |
| Skin | 48 | 37 | 1.14 (0.73 to 1.78) | 1.87 (1.41 to 2.48) | 1.66 (1.20 to 2.29) |
| Melanoma of skin | 6 | 3 | 1.54 (0.37 to 6.34) | 1.57 (0.70 to 3.49) | 1.00 (0.32 to 3.11) |
| Non-melanoma skin | 42 | 34 | 1.10 (0.69 to 1.76) | 1.92 (1.42 to 2.59) | 1.76 (1.26 to 2.46) |
| Breast | 14 | 14 | 0.73 (0.35 to 1.55) | 0.69 (0.41 to 1.16) | 0.89 (0.53 to 1.51) |
| Female genital organs | 9 | 2 | 3.92 (0.84 to 18.41) | 1.03 (0.53 to 1.97) | 0.30 (0.07 to 1.19) |
| Corpus uteri | 2 | 2 | 0.79 (0.11 to 5.58) | 0.53 (0.13 to 2.13) | 0.69 (0.17 to 2.75) |
| Ovary | 6 | 0 | – | 2.08 (0.94 to 4.64) | – |
| Male genital organs | 6 | 10 | 0.64 (0.22 to 1.83) | 0.89 (0.40 to 1.98) | 1.42 (0.76 to 2.63) |
| Prostate | 6 | 10 | 0.64 (0.22 to 1.83) | 0.94 (0.42 to 2.09) | 1.47 (0.79 to 2.72) |
| Urinary tract | 9 | 7 | 1.12 (0.41 to 3.09) | 1.31 (0.68 to 2.52) | 1.12 (0.54 to 2.36) |
| Urinary bladder | 5 | 5 | 0.77 (0.22 to 2.75) | 1.09 (0.45 to 2.61) | 1.16 (0.48 to 2.78) |
| Eye, brain, central nervous system | 1 | 6 | 0.20 (0.02 to 1.73) | 0.26 (0.04 to 1.85) | 2.01 (0.90 to 4.47) |
| Lymphatic and haematopoietic tissue | 14 | 9 | 1.25 (0.53 to 2.92) | 2.24 (1.33 to 3.79) | 1.66 (0.86 to 3.19) |
| Hodgkin lymphoma | 2 | 0 | – | 8.27 (2.07 to 33.1) | – |
| Non-Hodgkin lymphoma | 5 | 5 | 0.63 (0.18 to 2.20) | 1.88 (0.78 to 4.53) | 2.27 (0.94 to 5.45) |
| Multiple myeloma | 2 | 2 | 0.90 (0.13 to 6.44) | 1.68 (0.42 to 6.74) | 1.86 (0.47 to 7.45) |
| Lymphatic leukaemia | 3 | 1 | 3.18 (0.33 to 31.08) | 2.42 (0.78 to 7.49) | 0.87 (0.12 to 6.19) |
| Ill-defined and unspecified cancer | 4 | 2 | 1.51 (0.27 to 8.58) | 1.31 (0.49 to 3.48) | 0.68 (0.17 to 2.72) |
*Only specific cancer sites with more than three cases in tumour necrosis factor α inhibitor (TNF-I)-treated and non-treated combined are shown. Results for Hodgkin lymphoma are also presented.
†Estimated by HR ratios using Cox proportional hazard models with age as the underlying time scale and with further adjustment for sex and calendar time (2000–4, 2005–8). HR was not calculated for anlylosing spondylitis (AS), psoriatric arthritis (PSA) or other arthritides patients because of the small number of patients and short follow-up time in the non-TNF-I-treated group.
‡Estimated by standardised incidence ratios (SIR), ie, the ratio between observed and expected cancer cases during follow-up. The expected number of cancer cases was calculated by multiplying the number of person-years experienced by the cohort members with sex and 5-year age and calendar-specific incidence rates for first cancers in the general population in Denmark.
RA, rheumatoid arthritis.