Risk of lymphoma in patients exposed to antitumour necrosis factor therapy: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis
Risk of lymphoma in patients exposed to antitumour necrosis factor therapy: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis
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DOI：
10.1136/annrheumdis-2016-209389
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发表时间：
2017-03-01
影响因子：
27.4
通讯作者：
Hyrich, Kimme L.
中科院分区：
文献类型：
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作者：
Mercer, Louise K.;Galloway, James B.;Hyrich, Kimme L.
目的类风湿关节炎（RA）患者与普通人群相比，淋巴瘤的发病风险增加。有人担心，肿瘤坏死因子抑制剂（TNFi）可能会加剧这种风险。然而，由于RA中淋巴瘤的过度风险与炎症的累积负担有关，因此TNFi可能会通过降低炎症负担来降低淋巴瘤的风险。本研究的目的是比较淋巴瘤的风险与RA治疗TNFi与非生物therapeutic.Methods主题由风湿病学家诊断RA登记在英国风湿病学会风湿性关节炎登记（BSRBR-RA），一项前瞻性队列研究，随访到第一个淋巴瘤，死亡或直到2013年11月30日。使用考克斯回归比较了TNFi和非生物治疗队列中的淋巴瘤发病率。结果将11931例TNFi治疗患者与3367例生物治疗初治患者进行了比较。TNFi队列报告了84例淋巴瘤（88例（95% CI 70 - 109）/100 000人-年），生物学初治队列报告了30例淋巴瘤（154例（95% CI 104 - 220））。调整基线特征差异后，TNFi组与未接受过生物制剂治疗组的淋巴瘤风险无差异：HR 1.00（95% CI 0.56 - 1.80）。没有风险差异，观察个别TNFi.Conclusions在中期随访，没有证据表明，肿瘤坏死因子抑制影响淋巴瘤的风险超过背景风险与RA的主题。
Objectives Patients with rheumatoid arthritis (RA) are at increased risk of lymphoma compared with the general population. There are concerns that tumour necrosis factor inhibitors (TNFi) may exacerbate this risk. However, since the excess risk of lymphoma in RA is related to the cumulative burden of inflammation, TNFi may conversely reduce the risk of lymphoma by decreasing the burden of inflammation. The aim of this study was to compare the risk of lymphoma in subjects with RA treated with TNFi with those treated with non-biological therapy.Methods Subjects diagnosed by a rheumatologist with RA enrolled in the British Society for Rheumatology Rheumatoid Arthritis Register (BSRBR-RA), a prospective cohort study, were followed until first lymphoma, death or until 30 November 2013. Rates of lymphoma in the TNFi and non-biological-treated cohorts were compared using Cox regression.Results 11 931 TNFi-treated patients were compared with 3367 biological-naive patients. 84 lymphomas (88 (95% CI 70 to 109) per 100 000 person-years) were reported in the TNFi cohort and 30 lymphomas (154 (95% CI 104 to 220)) in the biological-naive cohort. After adjusting for differences in baseline characteristics, there was no difference in the risk of lymphoma for the TNFi versus the biological-naive group: HR 1.00 (95% CI 0.56 to 1.80). No risk differences were observed for individual TNFi.Conclusions In medium-term follow-up, there is no evidence that tumour necrosis factor inhibition influences the risk of lymphoma over the background risk in subjects with RA.