title: Detection and evaluation of a drug safety signal concerning pancreatic cancer: lessons from a joint approach of three European biologics registers.
abstract: OBJECTIVE
  A high incidence of pancreatic cancer (PCa) in patients exposed to was observed in the German biologics register. To evaluate this possible safety signal, a concerted analysis with the national biologics registers in the UK and Sweden was performed.
  
  
  METHODS
  Patients with enrolled in the British Society of Rheumatology Biologics Register (BSRBR), the Swedish Rheumatology Register (SRR) or the German Biologics Register [Rheumatoid Arthritis Observation of Biologic Therapy (RABBIT)] were analysed. The patients were exposed to biologic or conventional DMARDs. Outcomes were obtained from physician reports, health authorities and via linkage to national cancer and death registers. Age- and gender-standardized incidence ratios (SIRs) of PCa were calculated based on the expected rates available from the individual national cancer registers.
  
  
  RESULTS
  Data from 5126 (Germany), 16 930 (UK) and 19 351 (Sweden) RA patients were available for the analysis. The highly discrepant prescription rates of LEF in the respective countries resulted in 11 343 (Germany), 30 787 (UK) and 2518 (S) patient-years of exposure to LEF. Compared with the general population, the incidence of PCa in patients ever exposed to LEF corresponded to a SIR of 3.1 (95% CI 1.3, 6.5) in Germany, 1.05 (95% CI 0.5, 2.1) in the UK and 1.8 (95% CI 0.1, 10.2) in Sweden.
  
  
  CONCLUSIONS
  The results of the replication analyses do not support the hypothesis of an increased risk of PCa in patients exposed to treatment with LEF. However, they do not completely rule out concerns, and therefore further verification in other data sets is recommended.
authors.affiliation: Epidemiology Unit, German Rheumatism Research Centre, a Leibniz Institute, Charitéplatz 1, D-10117 Berlin, Germany. strangfeld@drfz.de
authors.forename: Anja
authors.initials: A
authors.lastname: Strangfeld
authors.forename: Kimme
authors.initials: K
authors.lastname: Hyrich
authors.forename: Johan
authors.initials: J
authors.lastname: Askling
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Arkema
authors.forename: Rebecca
authors.initials: R
authors.lastname: Davies
authors.forename: Joachim
authors.initials: J
authors.lastname: Listing
authors.forename: Martin
authors.initials: M
authors.lastname: Neovius
authors.forename: Julia
authors.initials: J
authors.lastname: Simard
authors.forename: Deborah
authors.initials: D
authors.lastname: Symmons
authors.forename: Kath
authors.initials: K
authors.lastname: Watson
authors.forename: Angela
authors.initials: A
authors.lastname: Zink
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000009:adverse effects*; D015415:Biomarkers; D015331:Cohort Studies; D005260:Female; D005858:Germany; D006801:Humans; D007555:Isoxazoles / Q000009:adverse effects*; D000077339:Leflunomide; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000139:chemically induced*; D012042:Registries / Q000592:standards*; D012307:Risk Factors; D013548:Sweden; D006113:United Kingdom; D044465:White People
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D015415:Biomarkers; D007555:Isoxazoles; D000077339:Leflunomide