Anti-Tumor Necrosis Factor Therapy in Rheumatoid Arthritis Patients Are Not Associated with Increased Lymphoma Risk
AK Wong, S Kerkoutian, JW Said, H Rashidi, ST Pullarkat. UCLA, Los Angeles, CA; UCSD, San Diego, CA
Background: The 2008 WHO recognizes a new diagnostic entity termed “other iatrogenic immunodeficiency-associated lymphoproliferative disorders” highlighting lymphomas that arise in patients treated with immunosuppressive agents for autoimmune disorders. The role of anti-tumor necrosis factor alpha therapy (TNF) and lymphoma risk in rheumatoid arthritis (RA) patients remains unclear; therefore, the goal of our study is to determine if anti-TNF therapy is associated with iatrogenic lymphomas.
Design: A meta-analysis of all English language randomized controlled clinical trials in RA patients receiving anti-TNF-alpha was performed. These studies were conducted between 2000-2006 and included 2306 control patients and 5179 patients treated with anti- TNF namely etanercept, adalumimab, and infliximab. Clinical information including total patients, age, gender, lymphoma rates, and follow-up time was recorded. The overall rate and rate differences were analyzed using the method of DerSimonian and Laird. P-value of <0.05 was considered significant.
Results: Table 1 summarizes the crude and adjusted overall lymphoma rates between the groups. The adjusted rate difference is 1.29 lymphomas per 1000 person-years (95% CI: -0.21, 2.8, p value = 0.093).
|Non-TNF Therapy||Anti-TNF Therapy|
|Number of Patients||2306||5179|
|Numbers of Patients with Lymphoma||4||11|
|Crude Lymphoma Rate||1.87||2.32|
|Adjusted Lymphoma Rate||0.36||1.65|
|Histologic Lymphoma Types||1 Hodgkin Lymphoma, 2 B-cell Lymphoma, 1 myeloma||1 Hodgkin Lymphoma, 4 B-cell lymphoma, 1 T-cell Lymphoma, 3 Unspecified Lymphoma, 2 Leukemia|