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Risk of solid cancers overall and by subtypes in patients with psoriatic arthritis treated with TNF inhibitors - a Nordic cohort study

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Hellgren, Karin ; Ballegaard, Christine ; Delcoigne, Bénédicte ; Cordtz, René ; Nordström, Dan ; Aaltonen, Kalle ; Gudbjornsson, Bjorn ; Love, Thorvardur Jon ; Aarrestad Provan, Sella ; Sexton, Joe ; Zobbe, Kristian ; Kristensen, Lars Erik ; Askling, Johan ; Dreyer, Lene. / Risk of solid cancers overall and by subtypes in patients with psoriatic arthritis treated with TNF inhibitors - a Nordic cohort study. I: Rheumatology (Oxford, England). 2021 ; Bind 60, Nr. 8. s. 3656-3668.

Bibtex

@article{697d9cd6709c40c8bbe464e0ecef5990,
title = "Risk of solid cancers overall and by subtypes in patients with psoriatic arthritis treated with TNF inhibitors - a Nordic cohort study",
abstract = "OBJECTIVES: To investigate whether TNF inhibitors (TNFi) are associated with increased risk of solid cancer in patients with psoriatic arthritis (PsA).METHODS: From the Nordic clinical rheumatology registers (CRR) here: SRQ/ARTIS (Sweden), DANBIO (Denmark), NOR-DMARD (Norway), ROB-FIN (Finland) and ICEBIO (Iceland) we identified PsA patients who started a first TNFi 2001-2017 (n = 9655). We identified patients with PsA not treated with biologics from (i) the CRR (n = 14 809) and (ii) the national patient registers (PR, n = 31 350). By linkage to the national cancer registers, we collected information on incident solid cancer overall and for eight cancer types. We used Cox regression to estimate hazard ratio (HR) with 95% CI of cancer (per country and pooled) in TNFi-exposed vs biologics-na{\"i}ve, adjusting for age, sex, calendar period, comorbidities and disease activity. We also assessed standardized incidence ratios (SIR) in TNFi-exposed PsA vs the general population (GP).RESULTS: We identified 296 solid cancers among the TNFi-exposed PsA patients (55 850 person-years); the pooled adjusted HR for solid cancer overall was 1.0 (0.9-1.2) for TNFi-exposed vs biologics-na{\"i}ve PsA from the CRR, and 0.8 (0.7-1.0) vs biologics-na{\"i}ve PsA from the PRs. There were no significantly increased risks for any of the cancer types under study. The pooled SIR of solid cancer overall in TNFi treated PsA vs GP was 1.0 (0.9-1.1).CONCLUSION: In this large cohort study from five Nordic countries, we found no increased risk of solid cancer in TNFi-treated PsA patients, neither for solid cancer overall nor for eight common cancer types.",
keywords = "Adult, Antirheumatic Agents/therapeutic use, Arthritis, Psoriatic/drug therapy, Cohort Studies, Female, Glucocorticoids/therapeutic use, Humans, Male, Methotrexate/therapeutic use, Middle Aged, Neoplasms/epidemiology, Proportional Hazards Models, Registries, Risk Factors, Scandinavian and Nordic Countries/epidemiology, Tumor Necrosis Factor Inhibitors/therapeutic use",
author = "Karin Hellgren and Christine Ballegaard and B{\'e}n{\'e}dicte Delcoigne and Ren{\'e} Cordtz and Dan Nordstr{\"o}m and Kalle Aaltonen and Bjorn Gudbjornsson and Love, {Thorvardur Jon} and {Aarrestad Provan}, Sella and Joe Sexton and Kristian Zobbe and Kristensen, {Lars Erik} and Johan Askling and Lene Dreyer",
note = "{\textcopyright} The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.",
year = "2021",
month = aug,
day = "2",
doi = "10.1093/rheumatology/keaa828",
language = "English",
volume = "60",
pages = "3656--3668",
journal = "Rheumatology",
issn = "1462-0324",
publisher = "Oxford University Press",
number = "8",

}

RIS

TY - JOUR

T1 - Risk of solid cancers overall and by subtypes in patients with psoriatic arthritis treated with TNF inhibitors - a Nordic cohort study

AU - Hellgren, Karin

AU - Ballegaard, Christine

AU - Delcoigne, Bénédicte

AU - Cordtz, René

AU - Nordström, Dan

AU - Aaltonen, Kalle

AU - Gudbjornsson, Bjorn

AU - Love, Thorvardur Jon

AU - Aarrestad Provan, Sella

AU - Sexton, Joe

AU - Zobbe, Kristian

AU - Kristensen, Lars Erik

AU - Askling, Johan

AU - Dreyer, Lene

N1 - © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

PY - 2021/8/2

Y1 - 2021/8/2

N2 - OBJECTIVES: To investigate whether TNF inhibitors (TNFi) are associated with increased risk of solid cancer in patients with psoriatic arthritis (PsA).METHODS: From the Nordic clinical rheumatology registers (CRR) here: SRQ/ARTIS (Sweden), DANBIO (Denmark), NOR-DMARD (Norway), ROB-FIN (Finland) and ICEBIO (Iceland) we identified PsA patients who started a first TNFi 2001-2017 (n = 9655). We identified patients with PsA not treated with biologics from (i) the CRR (n = 14 809) and (ii) the national patient registers (PR, n = 31 350). By linkage to the national cancer registers, we collected information on incident solid cancer overall and for eight cancer types. We used Cox regression to estimate hazard ratio (HR) with 95% CI of cancer (per country and pooled) in TNFi-exposed vs biologics-naïve, adjusting for age, sex, calendar period, comorbidities and disease activity. We also assessed standardized incidence ratios (SIR) in TNFi-exposed PsA vs the general population (GP).RESULTS: We identified 296 solid cancers among the TNFi-exposed PsA patients (55 850 person-years); the pooled adjusted HR for solid cancer overall was 1.0 (0.9-1.2) for TNFi-exposed vs biologics-naïve PsA from the CRR, and 0.8 (0.7-1.0) vs biologics-naïve PsA from the PRs. There were no significantly increased risks for any of the cancer types under study. The pooled SIR of solid cancer overall in TNFi treated PsA vs GP was 1.0 (0.9-1.1).CONCLUSION: In this large cohort study from five Nordic countries, we found no increased risk of solid cancer in TNFi-treated PsA patients, neither for solid cancer overall nor for eight common cancer types.

AB - OBJECTIVES: To investigate whether TNF inhibitors (TNFi) are associated with increased risk of solid cancer in patients with psoriatic arthritis (PsA).METHODS: From the Nordic clinical rheumatology registers (CRR) here: SRQ/ARTIS (Sweden), DANBIO (Denmark), NOR-DMARD (Norway), ROB-FIN (Finland) and ICEBIO (Iceland) we identified PsA patients who started a first TNFi 2001-2017 (n = 9655). We identified patients with PsA not treated with biologics from (i) the CRR (n = 14 809) and (ii) the national patient registers (PR, n = 31 350). By linkage to the national cancer registers, we collected information on incident solid cancer overall and for eight cancer types. We used Cox regression to estimate hazard ratio (HR) with 95% CI of cancer (per country and pooled) in TNFi-exposed vs biologics-naïve, adjusting for age, sex, calendar period, comorbidities and disease activity. We also assessed standardized incidence ratios (SIR) in TNFi-exposed PsA vs the general population (GP).RESULTS: We identified 296 solid cancers among the TNFi-exposed PsA patients (55 850 person-years); the pooled adjusted HR for solid cancer overall was 1.0 (0.9-1.2) for TNFi-exposed vs biologics-naïve PsA from the CRR, and 0.8 (0.7-1.0) vs biologics-naïve PsA from the PRs. There were no significantly increased risks for any of the cancer types under study. The pooled SIR of solid cancer overall in TNFi treated PsA vs GP was 1.0 (0.9-1.1).CONCLUSION: In this large cohort study from five Nordic countries, we found no increased risk of solid cancer in TNFi-treated PsA patients, neither for solid cancer overall nor for eight common cancer types.

KW - Adult

KW - Antirheumatic Agents/therapeutic use

KW - Arthritis, Psoriatic/drug therapy

KW - Cohort Studies

KW - Female

KW - Glucocorticoids/therapeutic use

KW - Humans

KW - Male

KW - Methotrexate/therapeutic use

KW - Middle Aged

KW - Neoplasms/epidemiology

KW - Proportional Hazards Models

KW - Registries

KW - Risk Factors

KW - Scandinavian and Nordic Countries/epidemiology

KW - Tumor Necrosis Factor Inhibitors/therapeutic use

UR - http://www.scopus.com/inward/record.url?scp=85103533257&partnerID=8YFLogxK

U2 - 10.1093/rheumatology/keaa828

DO - 10.1093/rheumatology/keaa828

M3 - Journal article

C2 - 33401297

VL - 60

SP - 3656

EP - 3668

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

IS - 8

ER -

ID: 67550112