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- Cordtz, R, et al.
(author)
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RISK OF HAEMATOLOGICAL MALIGNANCY IN PATIENTS WITH PSORIATIC ARTHRITIS, OVERALL AND IN RELATION TO TNF INHIBITORS - A NORDIC COHORT STUDY
- 2022
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In: ANNALS OF THE RHEUMATIC DISEASES. - : BMJ. - 0003-4967 .- 1468-2060. ; 81, s. 169-170
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Conference paper (other academic/artistic)abstract
- Several autoimmune inflammatory diseases, including rheumatoid arthritis (RA), are associated with increased risk of malignant lymphomas. There is also a longstanding concern of lymphoma development with tumour necrosis factor inhibitor (TNFi) treatment, but most studies in RA to date do not indicate an additionally increased risk. Corresponding studies in psoriatic arthritis (PsA), both with respect to the underlying risks, and risks in relation to treatment with TNFi, are limited. Data on myeloid malignancies in PsA are scarce.ObjectivesTo estimate the risk of haematological malignancy overall and by lymphoid and myeloid types in TNFi treated versus (vs.) biologics-naïve patients with PsA across the five Nordic countries. Additionally, we investigated the underlying risk of haematological malignancies in PsA as compared to the general population.MethodsWe identified patients with PsA starting a first ever TNFi from the clinical rheumatology registers (CRR) in Sweden (SE), Denmark (DK), Norway (NO), Finland (FI), and Iceland (ICE) from 2006 through 2019 (n=10 621). We identified biologics-naïve patients with PsA from a) the CRR (n=18 705, all countries) and b) the national patient registers (NPR, n=27 286, SE and DK only). To estimate the underlying risk of haematological malignancy in PsA, we randomly sampled general population comparators in SE and DK matched on year of birth, sex, and calendar year at start of follow-up, to the patients with PsA.Through linkage to the mandatory national cancer registers in all five countries, we collected information on haematological malignancy overall, and categorised into lymphoid or myeloid types. By applying a modified Poisson regression, we estimated pooled incidence rate ratio (IRR) with 95% confidence intervals (CI) for TNFi treated vs. biologics-naïve PsA and for PsA vs. the general population, adjusted for age (18-55, 56-65, 66-70, >70 years), sex, calendar period (2006-2010, 2011-2019) and country, and using robust standard errors.ResultsWe observed 40 events of haematological malignancies (during 59 827 person-years) among TNFi treated PsA, resulting in a crude incidence rate (IR) of 67 per 100 000 person-years. The corresponding IR was 91 (63 events) for biologics-naïve PsA from the CRR, and 118 (172 events) for biologics-naïve PsA from NPR. This resulted in a pooled IRR of 0.97 (0.69 to 1.37) for TNFi-treated vs. biologics-naïve PsA patients from the CRR, and 0.84 (0.64 to 1.10) vs. biologics-naïve PsA patients from the NPR. The pooled IRR of haematological malignancies in PsA overall vs. the general population was 1.35 (1.17 to 1.55). Throughout, the estimates were largely similar for lymphoid and myeloid malignancies (Figure 1). The crude IR of haematological malignancies were substantially akin across different TNFi agents.Figure 1.Pooled incidence rate ratios (IRRs) (95% CI) of haematological malignancy overall and by lymphoid and myeloid types, in first ever TNFi treated versus biologics-naïve patients with PsA, and versus general population comparators. Legend: Lymphoid malignancies include international classification of diseases (ICD) 10 codes C81-86, C88, C90-91. Myeloid malignancies include ICD10 codes C92-95, D45-D46, D47.1, D47.3-5. Incidence rate ratios adjusted for age (18-55, 56-65, 66-70, >70 years), sex, calendar period (2006-2010, 2011-2019) and country, and using robust standard errors.ConclusionIn this large five-country cohort study, we did not observe any increased risk of haematological malignancies overall, nor for lymphoid and myeloid types, in patients with PsA treated with TNFi. By contrast, there were signals of a moderately increased underlying risk of haematological malignancies, both of lymphoid and myeloid types, in patients with PsA overall as compared to the general population. The findings are of importance from a patient information perspective.AcknowledgementsWe would like to acknowledge the NordForsk and FOREUM, and especially the patient representatives of the NordForsk collaboration for their valuable contribution to this study.Disclosure of InterestsRené Cordtz: None declared, Johan Askling Consultant of: Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB, Grant/research support from: Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB, Bénédicte Delcoigne: None declared, Karin Ekström Smedby: None declared, Eva Baecklund: None declared, Christine Ballegaard: None declared, Pia Isomäki Speakers bureau: AbbVie, Eli Lilly and Pfizer, Consultant of: AbbVie, Eli Lilly, Pfizer, Roche and ViforPharma, Grant/research support from: Pfizer, Kalle Aaltonen: None declared, Björn Gudbjornsson Speakers bureau: Novartis, not related to this work, Consultant of: Novartis, not related to this work, Thorvardur Love Speakers bureau: Celgene, Sella Aa. Provan: None declared, Brigitte Michelsen Grant/research support from: Novartis, not related to this work, Joe Sexton: None declared, Lene Dreyer Speakers bureau: Eli Lilly, Galderma and Janssen, Grant/research support from: BMS not related to this work, Karin Hellgren: None declared
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- Wadstrom, H, et al.
(author)
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Risk of breast cancer before and after rheumatoid arthritis, and the impact of hormonal factors
- 2020
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In: Annals of the rheumatic diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 79:5, s. 581-586
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Journal article (peer-reviewed)abstract
- To examine the risk of incident breast cancer in women with rheumatoid arthritis (RA), and the risk of RA in women with a history of breast cancer, taking antihormonal treatment for breast cancer into account.MethodsUsing nationwide Swedish registers, women with new-onset RA diagnosed in 2006–2016 were identified and analysed using a cohort and a case–control design. Each patient with RA was matched on age, sex and place of residence to five randomly selected subjects from the general population. Through register linkages, we collected information on breast cancer, breast cancer risk factors (reproductive history and hormone replacement therapy) and socio-economy. The relative risk of breast cancer after RA was assessed using Cox regression, and the relative risk of RA in women with a history of breast cancer was assessed using conditional logistic regression.ResultsThe risk of incident breast cancer in women with RA was reduced and the association was not attenuated by adjustment for breast cancer risk factors (HR=0.80, 95% CI 0.68 to 0.93). The risk of RA in women with a history of breast cancer was similarly reduced (OR=0.87, 95% CI 0.79 to 0.95). Women with breast cancer treated with tamoxifen (OR=0.86, 95% CI 0.62 to 1.20) or aromatase inhibitors (OR=0.97, 95% CI 0.69 to 1.37) did not have an increased risk of RA compared with women with breast cancer treated differently.ConclusionsThe decreased occurrence of breast cancer in patients with RA is present already before RA diagnosis; these reduced risks are not readily explained by hormonal risk factors. Adjuvant antihormonal therapy for breast cancer does not seem to increase RA risk.
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- Wadstrom, H, et al.
(author)
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RISK OF BREAST CANCER BEFORE AND AFTER RHEUMATOID ARTHRITIS, AND THE IMPACT OF HORMONAL FACTORS
- 2020
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In: ANNALS OF THE RHEUMATIC DISEASES. - : BMJ. - 0003-4967 .- 1468-2060. ; 79, s. 81-81
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Conference paper (other academic/artistic)abstract
- Large cohort studies have consistently reported decreased occurrence of breast cancer among women with RA. However, both the reasons behind this decreased risk and if it is present already before RA diagnosis, is unclear. The occurrence of RA following breast cancer is clinically and etiologically important also for other reasons. Long-term adjuvant anti-hormonal treatment with tamoxifen or aromatase inhibitors has become mainstay for estrogen receptor positive breast cancer, but are often associated with arthralgia as a side effect. Some studies have suggested that these therapies not only induce arthralgia, but also inflammatory arthritis.Objectives:To examine the risk of incident breast cancer in women with RA, and the risk of RA in women with a history of breast cancer, taking anti-hormonal treatment for breast cancer into account.Methods:Using nationwide Swedish registers, women with new-onset RA diagnosed 2006-2016 were identified. Each RA patient was matched on age, sex, and place of residence to 5 randomly selected control subjects from the general population. Through register linkages, we collected information on breast cancer, breast cancer risk factors (age at childbirth, number of children, hormone replacement therapy), and socio-economy. The relative risk of breast cancer after RA was assessed using Cox regression, and the relative risk of RA in women with a history of breast was assessed using conditional logistic regression.Results:The risk of incident breast cancer in women with RA was reduced and the association was not attenuated by adjustment for breast cancer risk factors (HR=0.80, 95%CI 0.68-0.93)(Table 1). The risk was similar among seronegative RA, (HR=0.77, 95%CI 0.58-1.02), and seropositive RA, (HR=0.81, 95%CI, 0.67-0.98), and for all age groups. We noted reduced risks for all TNM stages, and for both pre- and postmenopausal breast cancer (assessed with age cutoff 50 years). The risk of RA in women with a history of breast cancer was similarly reduced (OR=0.87, 95%CI, 0.79-0.95). Odds ratios (OR) stratified by serostatus and age at RA diagnosis yielded similar results. There was no clear trend in the level of risk reduction when examining the risk by menopausal status, or cancer stage at breast cancer diagnosis. Women with breast cancer treated with tamoxifen (OR=0.86, 95%CI 0.62-1.20), or aromatase inhibitors (OR=0.97, 95%CI 0.69-1.37), did not have an increased risk of RA compared to women with breast cancer treated differently.Table 1.Risk of breast cancer in women with RA, overall and by serostatus (events and hazard ratios), and risk of RA in women with a history of breast cancer, overall and by serostatus (events and odds ratios)No. of breast cancers, patients with RANo. of breast cancers, comparators/controlsRR (95% CI)Risk of breast cancer in women with RA19011910.80 (0.68-0.93)Seronegative RA553460.77 (0.58-1.02)Seropositive RA1247720.81 (0.67-0.98)Risk of RA in women with breast cancer55531930.87 (0.79-0.95)Seronegative RA1579210.85 (0.71-1.01)Seropositive RA36720880.88 (0.78-0.98)Conclusion:There is a decreased risk of breast cancer in patients with RA, and a similar decrease in risk of breast cancer before RA diagnosis. We did not find evidence to support that the decreased risk of breast cancer was due to known risk determinants. Furthermore, adjuvant anti-hormonal therapy as used in secondary breast cancer pharmacoprevention did not seem to increase the risk of RA.Disclosure of Interests:Hjalmar WADSTRÖM: None declared, Andreas Pettersson: None declared, Karin Ekström Smedby: None declared, Johan Askling Grant/research support from: JA acts or has acted as PI for agreements between Karolinska Institutet and the following entities, mainly in the context of the ARTIS national safety monitoring programme of immunomodulators in rheumatology: Abbvie, BMS, Eli Lilly, Merck, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB Pharma
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