Drs. Askling and von Vollenhoven have each received consulting fees, speaking fees, and/or honoraria from Wyeth, Schering-Plough, and Abbott (less than $10,000 each).
Rheumatoid Arthritis Clinical Studies
Cancer risk in patients with rheumatoid arthritis treated with anti–tumor necrosis factor α therapies: Does the risk change with the time since start of treatment?
Version of Record online: 29 OCT 2009
Copyright © 2009 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 60, Issue 11, pages 3180–3189, November 2009
How to Cite
Askling, J., van Vollenhoven, R. F., Granath, F., Raaschou, P., Fored, C. M., Baecklund, E., Dackhammar, C., Feltelius, N., Cöster, L., Geborek, P., Jacobsson, L. T., Lindblad, S., Rantapää-Dahlqvist, S., Saxne, T. and Klareskog, L. (2009), Cancer risk in patients with rheumatoid arthritis treated with anti–tumor necrosis factor α therapies: Does the risk change with the time since start of treatment?. Arthritis & Rheumatism, 60: 3180–3189. doi: 10.1002/art.24941
- Issue online: 29 OCT 2009
- Version of Record online: 29 OCT 2009
- Manuscript Accepted: 11 JUL 2009
- Manuscript Received: 20 FEB 2009
- Swedish Cancer Society
- Stockholm County Council
- Swedish Biologics Register
- Abbott Immunology
- Bristol-Myers Squibb
- The South Swedish Anti-TNF Register has received funding from the King Gustav V
- Kock Foundations
- Swedish National Board of Health and Welfare
To determine the short-term and medium-term risks of cancer in patients receiving anti–tumor necrosis factor α (anti-TNFα) therapies that have proven effective in the treatment of chronic inflammatory conditions.
By linking together data from the Swedish Biologics Register, Swedish registers of RA, and the Swedish Cancer Register, we identified and analyzed for cancer occurrence a national cohort of 6,366 patients with RA who first started anti-TNF therapy between January 1999 and July 2006. As comparators, we used a national biologics-naive RA cohort (n = 61,160), a cohort of RA patients newly starting methotrexate (n = 5,989), a cohort of RA patients newly starting disease-modifying antirheumatic drug combination therapy (n = 1,838), and the general population of Sweden. Relative risks (RRs) were estimated using Cox regression analyses, examining overall RR as well as RR by time since the first start of anti-TNF therapy, by the duration of active anti-TNF therapy, and by the anti-TNF agent received.
During 25,693 person-years of followup in 6,366 patients newly starting anti-TNF, 240 first cancers occurred, yielding an RR of 1.00 (95% confidence interval 0.86–1.15) versus the biologics-naive RA cohort, and similar RRs versus the other 2 RA comparators. RRs did not increase with increasing time since the start of anti-TNF therapy, nor with the cumulative duration of active anti-TNF therapy. During the first year following the first treatment start, but not thereafter, dissimilar cancer risks for adalimumab, etanercept, and infliximab were observed.
During the first 6 years after the start of anti-TNF therapy in routine care, no overall elevation of cancer risk and no increase with followup time were observed.