Table 2

Association between exposure to TNFi and development of new solid cancer

 sDMARDTNFi
N=3249N=11 767
Ever-exposed to TNFi model
Total follow-up time (patient-years)11 67252 549
Follow-up per subject; median (IQR)4.1 (2.3, 5.0)5.0 (4.4, 5.0)
Cancers136427
Sources of reporting of solid cancers
 Cancer registry (%)126 (93)399 (93)
 Consultant/nurse (%)83 (61)322 (75)
 Patient (%)23 (17)79 (19)
 Incidence rate per 10 000 patient-years (95% CI)117 (98 to 138)81 (74 to 89)
 Unadjusted HR (95% CI)Referent0.70 (0.58 to 0.85)
 Age and sex adjusted HR (95% CI)Referent0.91 (0.75 to 1.11)
 PD adjusted HR (95% CI)Referent0.83 (0.64 to 1.07)
On TNFi (plus 90 days)*
Follow-up time (patient-years)10 27539 173
Cancers106285
PD adjusted HR (95% CI)Referent0.81 (0.60 to 1.10)
Cumulative exposure to TNFi
<1.5 years
 Follow-up time (patient-years)10 27520 264
 No. solid cancers106166
 PD adjusted HR (95% CI)Referent0.87 (0.66 to 1.15)
1.5 to <3 years
 Follow-up time (patient-years)10 27514 729
 No. solid cancers10699
 PD adjusted HR (95% CI)Referent0.85 (0.63 to 1.17)
 PD adjusted HR (95% CI); <1.5 years referent0.91 (0.67 to 1.24)
≥3 years
 Follow-up time (patient-years)10 27513 969
 No. solid cancers106100
 PD adjusted HR (95% CI)Referent0.77 (0.58 to 1.03)
 PD adjusted HR (95% CI); <1.5 years referent0.77 (0.58 to 1.02)
All follow-up time (including first 6 months)
Follow-up time (patient-years)13 42558 437
Cancers166449
Incidence rate per 10 000 patient-years (95% CI)124 (106 to 144)77 (70 to 84)
PD adjusted HR (95% CI)Referent0.77 (0.60 to 0.98)
Cancer registry reported cancers only
Follow-up time (patient-years)11 75852 549
Cancers126399
Incidence rate per 10 000 patient-years (95% CI)107 (89 to 128)76 (69 to 84)
PD adjusted HR (95% CI)Referent0.86 (0.66 to 1.13)
  • *Time after last received consultant follow-up form excluded from these analyses.

  • PD, propensity score stratified into deciles; sDMARD, synthetic disease modifying antirheumatic drug; TNFi, tumour necrosis factor inhibitor.