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Incidence of malignancy in adult patients with rheumatoid arthritis: a meta-analysis.

Simon TA, Thompson A, Gandhi KK, Hochberg MC, Suissa S - Arthritis Res. Ther. (2015)

Bottom Line: The standardized incidence ratios (SIRs; a measure of risk) relative to the general population were evaluated and compared with published rates.Patients with RA continued to show an increased risk of lymphoma and lung cancer compared with the general population.Overall, SIR estimates for colorectal and breast cancers continued to show a decrease in risk, whereas cervical cancer, prostate cancer and melanoma appeared to show no consistent trend in risk among patients with RA compared with the general population.

View Article: PubMed Central - PubMed

Affiliation: Bristol-Myers Squibb, Princeton, NJ, USA. teresa.simon@bms.com.

ABSTRACT

Introduction: Patients with rheumatoid arthritis (RA) are at an increased risk of malignancies compared with the general population. This has raised concerns regarding these patients, particularly with the widespread use of immunomodulating therapies, including biologic disease-modifying antirheumatic drugs (DMARDs). We performed a systematic literature review and analysis to quantify the incidence of malignancies in patients with RA and the general population to update previously published data.

Methods: A literature search was conducted that was consistent with and similar to that in a meta-analysis published in 2008. MEDLINE, BIOSIS Previews, Embase, Derwent Drug File and SciSearch databases were searched using specified search terms. Predefined inclusion criteria identified the relevant observational studies published between 2008 and 2014 that provided estimates of relative risk of malignancy in patients with RA compared with the general population. Risk data on overall malignancy and site-specific malignancies (lymphoma, melanoma and lung, colorectal, breast, cervical and prostate cancer) were extracted. The standardized incidence ratios (SIRs; a measure of risk) relative to the general population were evaluated and compared with published rates.

Results: A total of nine publications met the inclusion criteria. Seven of these reported SIRs for overall malignancy; eight for lymphoma, melanoma, and lung, colorectal and breast cancer; seven for prostate cancer; and four for cervical cancer. Compared with those in the general population, the SIR estimates for patients with RA suggest a modest increased risk in overall malignancy, as previously observed. Patients with RA continued to show an increased risk of lymphoma and lung cancer compared with the general population. Overall, SIR estimates for colorectal and breast cancers continued to show a decrease in risk, whereas cervical cancer, prostate cancer and melanoma appeared to show no consistent trend in risk among patients with RA compared with the general population.

Conclusions: The additional data evaluated here are consistent with previously reported data. Patients with RA are at an increased risk of lung and lymphoma malignancies compared with the general population. Quantifying differences in malignancy rates between non-biologic and biologic DMARD-treated patients with RA may further highlight which malignancies may be related to treatment rather than to the underlying disease.

No MeSH data available.


Related in: MedlinePlus

Literature search data
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Fig1: Literature search data

Mentions: A total of 136 articles were identified using the defined search criteria (Fig. 1). Following identification, a total of 33 potential publications were further analyzed; of these, 9 studies met all the inclusion criteria (Fig. 1) [10, 12–19]. These studies included population- and community-based RA cohorts, examined data from 458 to 84,475 patients and had mean follow-up periods ranging from 4 to 25 years. The relative risk of overall malignancy was reported in seven studies [12–15, 17–19]; lymphoma (overall lymphoma, Hodgkin disease or non-Hodgkin lymphoma), lung, colorectal and breast cancers and melanoma in eight [10, 12–17, 19]; prostate cancer in seven [10, 12–17]; and cervical cancer in four [12, 14, 16, 17]. Overall risk by malignancy type was reported in eight studies [10, 12–17, 19], both overall risk and risk by sex were reported in three [15, 17, 18] and risk stratified by sex only was reported in one [16].Fig. 1


Incidence of malignancy in adult patients with rheumatoid arthritis: a meta-analysis.

Simon TA, Thompson A, Gandhi KK, Hochberg MC, Suissa S - Arthritis Res. Ther. (2015)

Literature search data
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536786&req=5

Fig1: Literature search data
Mentions: A total of 136 articles were identified using the defined search criteria (Fig. 1). Following identification, a total of 33 potential publications were further analyzed; of these, 9 studies met all the inclusion criteria (Fig. 1) [10, 12–19]. These studies included population- and community-based RA cohorts, examined data from 458 to 84,475 patients and had mean follow-up periods ranging from 4 to 25 years. The relative risk of overall malignancy was reported in seven studies [12–15, 17–19]; lymphoma (overall lymphoma, Hodgkin disease or non-Hodgkin lymphoma), lung, colorectal and breast cancers and melanoma in eight [10, 12–17, 19]; prostate cancer in seven [10, 12–17]; and cervical cancer in four [12, 14, 16, 17]. Overall risk by malignancy type was reported in eight studies [10, 12–17, 19], both overall risk and risk by sex were reported in three [15, 17, 18] and risk stratified by sex only was reported in one [16].Fig. 1

Bottom Line: The standardized incidence ratios (SIRs; a measure of risk) relative to the general population were evaluated and compared with published rates.Patients with RA continued to show an increased risk of lymphoma and lung cancer compared with the general population.Overall, SIR estimates for colorectal and breast cancers continued to show a decrease in risk, whereas cervical cancer, prostate cancer and melanoma appeared to show no consistent trend in risk among patients with RA compared with the general population.

View Article: PubMed Central - PubMed

Affiliation: Bristol-Myers Squibb, Princeton, NJ, USA. teresa.simon@bms.com.

ABSTRACT

Introduction: Patients with rheumatoid arthritis (RA) are at an increased risk of malignancies compared with the general population. This has raised concerns regarding these patients, particularly with the widespread use of immunomodulating therapies, including biologic disease-modifying antirheumatic drugs (DMARDs). We performed a systematic literature review and analysis to quantify the incidence of malignancies in patients with RA and the general population to update previously published data.

Methods: A literature search was conducted that was consistent with and similar to that in a meta-analysis published in 2008. MEDLINE, BIOSIS Previews, Embase, Derwent Drug File and SciSearch databases were searched using specified search terms. Predefined inclusion criteria identified the relevant observational studies published between 2008 and 2014 that provided estimates of relative risk of malignancy in patients with RA compared with the general population. Risk data on overall malignancy and site-specific malignancies (lymphoma, melanoma and lung, colorectal, breast, cervical and prostate cancer) were extracted. The standardized incidence ratios (SIRs; a measure of risk) relative to the general population were evaluated and compared with published rates.

Results: A total of nine publications met the inclusion criteria. Seven of these reported SIRs for overall malignancy; eight for lymphoma, melanoma, and lung, colorectal and breast cancer; seven for prostate cancer; and four for cervical cancer. Compared with those in the general population, the SIR estimates for patients with RA suggest a modest increased risk in overall malignancy, as previously observed. Patients with RA continued to show an increased risk of lymphoma and lung cancer compared with the general population. Overall, SIR estimates for colorectal and breast cancers continued to show a decrease in risk, whereas cervical cancer, prostate cancer and melanoma appeared to show no consistent trend in risk among patients with RA compared with the general population.

Conclusions: The additional data evaluated here are consistent with previously reported data. Patients with RA are at an increased risk of lung and lymphoma malignancies compared with the general population. Quantifying differences in malignancy rates between non-biologic and biologic DMARD-treated patients with RA may further highlight which malignancies may be related to treatment rather than to the underlying disease.

No MeSH data available.


Related in: MedlinePlus