Concurrent Oral 7 – Rheumatoid Arthritis: Clinical Aspects [OP48–OP53]

• Published in: Rheumatology (Oxford, England) England), 2010-04, Vol.49 (suppl-1), p.i21-i23
• Main Authors: Mercer, Louise K., Dixon, William G., Watson, Kath D., Galloway, James, Lunt, Mark, Symmons, Deborah P., Hyrich, Kimme L., Hyrich, Kimme, Mercer, Louise, Dixon, Will, Ustianowski, Andy, Watson, Kath, Symmons, Deborah, Mirjafari, Hoda, Charlton-Menys, Valentine, Bunn, Diane, Edlin, Helena, Marshall, Tarnya, Wilson, Paddy, Bruce, Ian N., Goodson, Nicola J., Morgan, Kate, Marks, Jeff, Gullick, Nicola, Oakley, Stephen, Jones, Tim, Mistlin, Alan, Rees, Jon, Gibson, Terence, Panayi, Gabriel, Kirkham, Bruce, Ma, Margaret H., Ibrahim, Fowzia, Pollard, Louise, Fekete, Zsuzsa, Kingsley, Gabrielle H., Scott, David L.
• Format: Article
• Language: English
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/keq707

Background: Rheumatoid arthritis (RA) is associated with an increased risk of basal cell (BCC) and squamous cell (SCC) non-melanoma skins cancers (NMSC). Anti-TNF therapy may intensify this risk, although evidence to date is conflicting. Our aim was to explore the influence of anti-TNF therapy on the incidence of NMSC in patients with RA using data from the BSRBR. Methods: 11639 patients with RA starting anti-TNF therapy and 3505 biologic-naïve subjects with active RA receiving traditional disease modifying therapy (DMARD) were compared for rates of NMSC. Patients were followed up until 12/31/2008 or death, whichever came first. Patients with a history of NMSC prior to entering the study identified by record linkage with the UK national cancer registry (NHS-IC) were excluded. Incident NMSC were identified from consultant and patient questionnaires and record linkage with the NHS-IC. Only confirmed cases were included in the analysis (histology, NHS-IC reported, or definitive cancer treatment). NMSC occurring after stopping anti-TNF was attributed to the most recent anti-TNF drug. The rates of NMSC in the anti-TNF and DMARD cohorts were compared using multivariate Cox proportional hazards models adjusted for age, gender, disease duration, disease activity, HAQ, baseline steroid use, number of prior DMARDs, smoking and year of registration. Results: 184 NMSC were verified: 155 in the anti-TNF cohort and 29 in the DMARD cohort. The ratio of BCC:SCC was similar in both cohorts: anti-TNF 88%:11%, DMARD 81%:19%. Age and male gender were associated with an increased risk of NMSC in multivariate analysis. The fully adjusted hazard ratio (aHR) of total NMSC for anti-TNF vs DMARD was 1.7 (95% CI 0.9, 3.0). The aHR was 1.6 (0.9, 3.0) for etanercept (ETA), 2.7 (1.4, 5.1) for infliximab (INF) and 1.2 (0.6, 2.3) for adalimumab (ADA). This difference in risk remained if analysis was limited to the first anti-TNF therapy only. The risk in infliximab was attenuated when analysis was limited to the first NMSC only (Table). Conclusions: In patients with no prior NMSC, the risk of total NMSCs was increased by 70% in patients with RA treated with anti-TNF therapy, although this was not significant. INF was associated with an almost three-fold increase in risk of NMSC, although this may be in part explained by more common multiple lesions. Vigilance for NMSC should be maintained in all patients with RA, especially when treated with anti-TNF therapy. DMARD Anti-TNF Etanercept In