RESEARCH - Risks of solid cancers in patients with RA and following treatment with TNF-antagonists.

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Ann Rheum Dis. 2005 Apr 13; [Epub ahead of print]

Risks of solid cancers in patients with rheumatoid arthritis and following

treatment with tnf-antagonists.

Askling J, Fored M, Brandt L, Baecklund E, Bertilsson L, Feltelius N, Coster

L, Geborek P, sson L, Lindblad S, Lysholm J, Rantapaa-Dahlqvist S,

Saxne T, Klareskog L.

Karolinska Institutet, Sweden.

BACKGROUND: Existing studies of solid cancers in RA reflect cancer morbidity

up until the early 1990ies in prevalent cohorts hospitalized during the

1980ies. To depict the cancer-pattern of contemporary RA-patients, we thus

need updated risk-data from prevalent and incident RA-populations. To

understand the risk of solid cancer following TNF-antagonists we need

cancer-data from cohorts treated in routine care rather than trials.

METHODS: We performed a population-based study of three RA-cohorts (one

prevalent, hospitalized 1990-2003 [n=53,067], one incident, diagnosed

1995-2003 [n=3,703], and one treated with TNF-antagonists 1999-2003

[n=4,160]) which were linked with Swedish nation-wide cancer- and

census-registers and followed for cancer occurrence (versus general

population) through 2003. RESULTS: With 3,379 observed cancers, the

prevalent RA-cohort was at marginally elevated overall risk of solid cancer,

at 20-50% increased risks for smoke-related cancers, at increased risk for

non- melanoma skin cancer (+70%), but at decreased risk for breast (-20%)

and colorectal cancer (-25%). With 138 cancers, incident RA displayed a

similar cancer pattern apart from non-decreased risks for colorectal cancer.

TNF-antagonist treated patients displayed solid cancer (n=67) risks largely

similar to those of other RA- patients.

CONCLUSION: The cancer pattern in patients treated with TNF-antagonists so

far mirror those of other contemporary as well as historic RA cohorts. The

consistent increase in smoking-associated cancers in RA patients emphasizes

the potential for smoke-cessation as a cancer-preventive measure in RA.

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