Table 2.
Structured Review of Results of Cohort Studies Regarding Cancer Risk Associated with TNF Inhibitors
| Author, Year (reference) | TNFi-Treated | Reference Exposure | Results‡ (95% Confidence Interval) | ||
|---|---|---|---|---|---|
| N events | Person-years | N events | Person-years | ||
| Askling, 2009 (20) | 240 | 25,693 (25, 698 for biologics naïve comparison) | biologics naïve: 4,244 MTX: 260 nbDMARDs: 64 |
330,498 23,558 7,034 |
RR: 1.0 (0.87–1.17) RR: 0.99 (0.79–1.24) RR: 0.97 (0.69–1.36) |
| Askling, 2009 (18) | 26 | 26,981 | National RA TNFi naïve: 336 | 365,026 | Lymphoma RR: 1.35 (0.82 to 2.11) |
| Askling, 2005 (19) | 9 | 9,715 | 319 | 297,102 | Lymphoma RR: 1.1 (0.6–2.1) |
| Bernatsky, 2008 (26) | 2 | NA | 19 | NA | Lung Cancer RR: 0.84 (0.19–3.73) |
| Bernatsky, 2008 (27) | 3 | NA | 12 | NA | Hematologic malignancy RR: 1.92 (0.49–7.50) |
| Chakavarty, 2005 (21) | Not specified | 40,125 | Not specified | Not specified | NMSC HR: TNFi: 1.24 (0.97–1.58, p = 0.89) TNFi and MTX: 1.97 (1.51–2.58, p = 0.001) |
| Geborek, 2005 (22) | 16 tumors, 5 lymphomas | 1,603 | TNFi naïve: 69 tumors, 2 lymphomas | 3,948 | Lymphoma HR: 4.9 (0.9–26.2, p =0.07) |
| Setoguchi, 2006 (23) | *88 hematologic, 11 solid | 2,940 | MTX: 88 hematologic, 558 solid | 30,300 | HR: 0.98 (0.75–1.3) Lymphoproliferative HR: 1.11 (0.51–2.37) Hematologic malignancy HR: 1.37 (0.71–2.65) Solid tumor HR: 0.91 (0.65–1.26) |
| Wolfe, 2007 (25) | TNFi: 95 Biologic and MTX: Not specified |
10,364† 10,364† |
TNFi naïve: Not specified MTX only: Not specified |
Not specified Not specified |
Lymphoma OR: 1.0 (0.6–1.8, p = 0.875) OR: 1.1 (0.6–2.0, p =0.710) |
| Wolfe, 2007 (24) |
* All: 231 Leukemia: 13 Lymphoma: 23 Melanoma: 23 NMSC: 308 |
13,001† | TNFi naïve: All: 306 Leukemia: 11 Lymphoma: 22 Melanoma: 9 NMSC: 315 |
Not specified | OR: 1.0 (0.8–1.2) Leukemia OR: 1.2 (0.5–3.1) Lymphoma OR:1.0 (0.5–2.0) Melanoma OR:2.3 (0.9–5.4) NMSC OR: 1.5 (1.2–1.8) |
| Dixon, 2010 (35) | TNFi: 13 | 515 | DMARDs only: 9 | 235 | RR: 0.45 (0.09–2.17) |
Also included anakinra (n= 11 for Setoguchi and n = 6 for overall cancers for Wolfe)
Reports persons not person-years for entire cohort analyzed. Persons by comparison group or by person-years were not available.
Results are for all cancers unless specified. The cancers reported in the Results column were chosen based on several criteria: the main outcome of a given study; the risk of cancer overall; and the risk of solid tumors, lymphoma, leukemia, or skin cancer.
Abbreviations: RA, rheumatoid arthritis; MTX, methotrexate; TNFi, tumor necrosis factor inhibitor; RR, relative risk; SIR, standardized incidence ratio; RR, relative risk; HR, hazard ratio; OR, odds ratio; NMSC, non-melanoma skin cancer; NA, not applicable in a case-control study.