Malignancies in patients on biologics (observational studies)
| Study ID | Registry | Intervention | Control csDMARDs | Control general population | aHR (Intervention vs comparator/control) | aHR (intervention vs general population) | Risk of bias |
|---|---|---|---|---|---|---|---|
| All types of cancer | |||||||
| Askling (2009) A&R33 | ARTIS | 3 TNFi | csDMARDs | General population | TNFi vs pts starting MTX: 1.0 (0.8, 1.2); TNFi vs csDMARDs combination therapy 1.0 (0.7, 1.4) | 1.1 (1.0, 1.3) | Low |
| Carmona (2011) Semin Arthritis Rheum34 | BIOBADASER | 3 TNFi | csDMARDs | General population | 0.5 (0.1, 2.5) | 0.7 (0.5, 0.9) | Low |
| Hayes (2013) A&R35 | Claim database | 3 TNFi | csDMARDs | NA | 0.8 (0.6, 1.1); ever-analysis 0.9 (0.8, 1.1) | NA | Moderate |
| Pallavicini (2010) Autoimmunity Reviews36 | LORHEN | 3 TNFi | NA | General population | NA | Milan*: 0.9 (0.6, 1.5), Varese 1.1 (0.6, 1.7); Solid cancer Milan: 0.7 (0.4, 1.2), Varese 0.9 (0. 5, 1.5) | Moderate |
| Strangfeld (2010) AR&T37 | RABBIT | 3 TNFi+anakinra | csDMARDs | General population | TNFi vs csDMARDs 0.7 (0.4, 1.1); ANA vs csDMARDs 1.4 (0.6, 3.5) | 0.8 (0.5, 1.0) | Low |
| Patients with history of cancer | |||||||
| Dixon (2010) AC&R38 | BSRBR | 3 TNFi | csDMARDs | NA | 0.5 (0.1, 2.2); Censoring after 1st cancer 0.5 (0.1, 2.2) | NA | Low |
| Lymphoma | |||||||
| Askling (2009) ARD39 | ARTIS | 3 TNFi | csDMARDs | General population | 1.4 (0.8, 2.1) | 2.7 (1.8, 4.1) | Low |
| Mariette (2010) ARD40 | RATIO | 3 TNFi | General population | NA | 2.3 (1.6, 3.3) | Low | |
| Carmona (2011) Semin Arthritis Rheum34 | BIOBADASER | 3 TNFi | csDMARDs | General population | NA | Hodgkin 5.3 (0.1, 29.5); non-Hodgkin 1.5 (0.31, 4.4) | Low |
| Haynes (2013) A&R35 | Claim database | 3 TNFi | csDMARDs | NA | 0.8 (0.3, 2.1), ever-analysis 1.3 (0.7, 2.2); any lymphoma or leukemia: 0.7 (0.3, 1.5); ever-analysis (1.0 (0.6, 1.6) | NA | Moderate |
| Pallavicini (2010) Autoimmunity Reviews36 | LOHREN | 3 TNFi | NA | General population | NA | Milan 6.0 (1.6, 15.4), Varese 5.0 (1.3, 12.7); Haematological cancer Milan 4.1 (1.3, 9.5), Varese 4.1 (1.3, 9.5) | Moderate |
| Non-melanoma skin cancer | |||||||
| Amari (2011) Rheumatology41 | Claim database | 3 TNFi | csDMARDs | NA | 1.4 (1.2, 1.6); TNFi vs MTX 1.4 (1.2, 1.7) | NA | Moderate |
| Mercer (2012) ARD42 | BSRBR | 3 TNFi | csDMARDs | General population | BCC 1.0 (0.5, 1.7), SCC 1.2 (0.4, 3.8); 1st cancer per subject BCC 0.8 (0. 5, 1.5) | 1.7 (1.4, 2.0) | Low |
| Haynes (2013) A&R35 | Claim database | 3 TNFi | csDMARDs | NA | 0.8 (0.5, 1.4); ever-analysis 1.1 (0.8, 1.5) | NA | Moderate |
| Melanoma | |||||||
| Raaschou (2013) BMJ43 | ARTIS | 5 TNFi | csDMARDs | NA | 1.5 (1.0, 2.2) | NA | Low |
More details are found in online supplementary tables S27–S50.
*Milan refers the Milan Cancer Report and Varese to the Varese Cancer Registry database. These were the general population comparators used.
aHR, adjusted HR; ANA, anakinra; ARTIS, Swedish Biologics Register; BCC, basal cell carcinoma; BIOBADASER, Spanish Biologics Register; BSRBR, British Society of Rheumatology Biologics Register; csDMARDs, conventional synthetic disease-modifying antirheumatic drugs; LOHREN, Lombardy Rheumatology Network (Italian Biologics Register); MTX, methotrexate; NA, not available (not mentioned in the original article); pts, patients; RABBIT, Rheumatoid Arthritis Observation of Biologic Therapy (RABBIT (in German)); RATIO, French Biologics Register; SCC, squamous cell carcinoma; TNFi, tumour necrosis factor α inhibitor.