Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Ann Rheum Dis. 2017 Jan;76(1):105-111. doi: 10.1136/annrheumdis-2016-209270. Epub 2016 May 4.
Safety data on cancer risks following tumour necrosis factor α inhibitors (TNFi) in patients with spondyloarthritis (SpA) (here defined as ankylosing spondylitis (AS), undifferentiated spondarthropaties (SpA UNS), psoriatic arthritis (PsA)) are scarce. Our objective was to assess risks for cancer overall and for common subtypes in patients with SpA treated with TNFi compared with TNFi-naïve patients with SpA and to the general population.
From the Swedish (Anti-Rheumatic Therapy in Sweden (ARTIS)) and Danish (DANBIO) biologics registers, we assembled 8703 (ARTIS=5448, DANBIO=3255) patients with SpA initiating a first TNFi 2001-2011. From the Swedish National Patient and Population Registers we assembled a TNFi-naïve SpA cohort (n=28,164) and a Swedish age-matched and sex-matched general population comparator cohort (n=131 687). We identified incident cancers by linkage with the nationwide Swedish and Danish Cancer Registers 2001-2011, and calculated age-standardised and sex-standardised incidence ratios as measures of relative risk (RR).
Based on 1188 cancers among the TNFi-naïve patients with SpA, RR of cancer overall was 1.1 (95% CI 1.0 to 1.2). Based on 147 cancers among TNFi initiators with SpA, RR versus TNFi-naïve was 0.8 (95% CI 0.7 to 1.0) and results were similar for AS and PsA when analysed separately. Site-specific cancer RRs: prostate 0.5 (95% CI 0.3 to 0.8), lung 0.6 (95% CI 0.3 to 1.3), colorectal 1.0 (95% CI 0.5 to 2.0), breast 1.3 (95% CI 0.9 to 2.0), lymphoma 0.8 (95% CI 0.4 to 1.8) and melanoma 1.4 (95% CI 0.7 to 2.6).
In patients with SpA, treatment with TNFi was not associated with increased risks of cancer, neither overall nor for the six most common cancer types.
在患有脊柱关节炎（SpA）的患者中，肿瘤坏死因子 α 抑制剂（TNFi）治疗后的癌症风险数据（此处定义为强直性脊柱炎（AS）、未分化脊柱关节病（SpA UNS）、银屑病关节炎（PsA））很少。我们的目的是评估 SpA 患者接受 TNFi 治疗与 SpA 患者未接受 TNFi 治疗和普通人群相比，总体癌症风险和常见亚型的风险。
我们从瑞典（抗风湿治疗登记处（ARTIS））和丹麦（DANBIO）生物制剂登记处中收集了 2001-2011 年间首次接受 TNFi 治疗的 8703 名 SpA 患者（ARTIS=5448，DANBIO=3255）。我们从瑞典国家患者和人口登记处收集了一个 TNFi 未治疗的 SpA 队列（n=28164）和一个瑞典年龄和性别匹配的普通人群对照组队列（n=131687）。我们通过与全国瑞典和丹麦癌症登记处的链接来确定新发病例，使用年龄标准化和性别标准化发病率比作为相对风险（RR）的衡量标准。
基于 TNFi 未治疗的 SpA 患者的 1188 例癌症，总体癌症 RR 为 1.1（95%CI 1.0 至 1.2）。基于 TNFi 启动者中 147 例癌症，与 TNFi 未治疗者的 RR 为 0.8（95%CI 0.7 至 1.0），当单独分析 AS 和 PsA 时，结果相似。特定部位癌症 RR：前列腺 0.5（95%CI 0.3 至 0.8），肺 0.6（95%CI 0.3 至 1.3），结直肠 1.0（95%CI 0.5 至 2.0），乳腺 1.3（95%CI 0.9 至 2.0），淋巴瘤 0.8（95%CI 0.4 至 1.8）和黑色素瘤 1.4（95%CI 0.7 至 2.6）。
在 SpA 患者中，TNFi 治疗与癌症风险增加无关，无论是总体癌症风险还是最常见的六种癌症类型。
