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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

Relative risk of non-Hodgkin lymphoma in patients with rheumatoid arthritis (RA) compared with the general population. CI, confidence interval; DMARD, disease-modifying antirheumatic drug; n, number of malignancies; N, population size; SIR, standardized incidence ratio. *SIRs by sex included in total pooled SIR only if overall SIR was not available
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Fig5: Relative risk of non-Hodgkin lymphoma in patients with rheumatoid arthritis (RA) compared with the general population. CI, confidence interval; DMARD, disease-modifying antirheumatic drug; n, number of malignancies; N, population size; SIR, standardized incidence ratio. *SIRs by sex included in total pooled SIR only if overall SIR was not available

Mentions: In eight studies, authors reported outcomes as either overall lymphoma, Hodgkin disease or non-Hodgkin lymphoma [10, 12–17, 19]. Two studies reported only lymphoma, whereas the remaining six studies reported overall lymphoma, Hodgkin disease and non-Hodgkin lymphoma rates, with all of the new studies reporting a significant increase in risk of lymphoma in patients with RA compared with the general population (Figs. 3, 4 and 5). This ranged from almost a doubling (SIR 1.75) (Fig. 3) [10, 15, 17, 21, 23, 24, 29, 30, 33] to a 12-fold increase (SIR 12.82) (Fig. 4) [12, 14–16, 19, 22, 24, 25, 27–29, 34, 35] in the risk of developing lymphoma. The pooled SIR for Hodgkin disease (Fig. 4) was higher than for non-Hodgkin lymphoma (Fig. 5) [12–16, 19, 20, 22, 24, 25, 27–29, 34–36]. The total pooled SIR (95 % CI) for the studies reviewed here and by Smitten et al. [6] was 2.46 (2.05–2.96) for malignant lymphoma, 3.21 (2.42–4.27) for Hodgkin disease and 2.26 (1.82–2.81) for non-Hodgkin lymphoma. The overall risk with the addition of the new studies is consistent with previously reported SIRs (2.08 [1.80–2.39], 3.29 [2.56–4.22] and 1.95 [1.70–2.24], respectively) [6]; however, a slight increase in risk for non-Hodgkin disease was noted.Fig. 3


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)

Relative risk of non-Hodgkin lymphoma in patients with rheumatoid arthritis (RA) compared with the general population. CI, confidence interval; DMARD, disease-modifying antirheumatic drug; n, number of malignancies; N, population size; SIR, standardized incidence ratio. *SIRs by sex included in total pooled SIR only if overall SIR was not available
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig5: Relative risk of non-Hodgkin lymphoma in patients with rheumatoid arthritis (RA) compared with the general population. CI, confidence interval; DMARD, disease-modifying antirheumatic drug; n, number of malignancies; N, population size; SIR, standardized incidence ratio. *SIRs by sex included in total pooled SIR only if overall SIR was not available
Mentions: In eight studies, authors reported outcomes as either overall lymphoma, Hodgkin disease or non-Hodgkin lymphoma [10, 12–17, 19]. Two studies reported only lymphoma, whereas the remaining six studies reported overall lymphoma, Hodgkin disease and non-Hodgkin lymphoma rates, with all of the new studies reporting a significant increase in risk of lymphoma in patients with RA compared with the general population (Figs. 3, 4 and 5). This ranged from almost a doubling (SIR 1.75) (Fig. 3) [10, 15, 17, 21, 23, 24, 29, 30, 33] to a 12-fold increase (SIR 12.82) (Fig. 4) [12, 14–16, 19, 22, 24, 25, 27–29, 34, 35] in the risk of developing lymphoma. The pooled SIR for Hodgkin disease (Fig. 4) was higher than for non-Hodgkin lymphoma (Fig. 5) [12–16, 19, 20, 22, 24, 25, 27–29, 34–36]. The total pooled SIR (95 % CI) for the studies reviewed here and by Smitten et al. [6] was 2.46 (2.05–2.96) for malignant lymphoma, 3.21 (2.42–4.27) for Hodgkin disease and 2.26 (1.82–2.81) for non-Hodgkin lymphoma. The overall risk with the addition of the new studies is consistent with previously reported SIRs (2.08 [1.80–2.39], 3.29 [2.56–4.22] and 1.95 [1.70–2.24], respectively) [6]; however, a slight increase in risk for non-Hodgkin disease was noted.Fig. 3

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