title: Risk of virus-associated cancer in female arthritis patients treated with biological DMARDs-a cohort study.
abstract: To investigate the risk of virus-associated cancer in female arthritis patients ever treated with biological DMARDs (bDMARDs) compared with never bDMARD-treated patients and ever and never treated with bDMARD compared with the general population.
  
  
  
  This was a cohort study that included 13 905 female patients with RA (72%), PsA (12%), AS (4%) or other arthritides (12%) identified in the DANBIO registry. Ever (n = 5647) and never (n = 10 331) bDMARD-treated patients were followed for virus-associated cancers during 2000-11 by linkage to the Danish Cancer Registry. Hazard ratios and standardized incidence ratios (SIRs) were calculated.
  
  
  
  In total, 24 and 32 virus-associated cancers were identified among ever and never bDMARD users, respectively (hazard ratio = 0.9, 95% CI: 0.7, 1.2). Oropharyngeal (n = 3, SIR = 4.0, 95% CI: 1.3, 12.4) and anal (n = 2, SIR = 2.5, 95% CI: 0.6, 10.0) cancer only occurred among bDMARD-treated patients. SIR was not increased for cervical cancer, either in ever or never bDMARD-treated patients. SIRs for Hodgkin's and non-Hodgkin's lymphomas were increased in never bDMARD-treated patients (SIR = 2.5, 95% CI: 1.5, 4.0).
  
  
  
  bDMARD therapy was not associated with an overall excess of virus-associated cancers in female arthritis patients. The observed increased occurrence of oropharyngeal cancer needs further investigation. Lymphoma incidence was increased in patients unexposed to bDMARD treatment.
authors.affiliation: Department of Rheumatology, Herlev and Gentofte University Hospital, Hellerup rcordtz@gmail.com.
authors.forename: René
authors.initials: R
authors.lastname: Cordtz
authors.affiliation: Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen.
authors.forename: Lene
authors.initials: L
authors.lastname: Mellemkjær
authors.affiliation: Department of Rheumatology, Herlev and Gentofte University Hospital, Hellerup.
authors.forename: Bente
authors.initials: B
authors.lastname: Glintborg
authors.affiliation: DANBIO Registry and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen.
authors.forename: Merete Lund
authors.initials: ML
authors.lastname: Hetland
authors.affiliation: Department of Rheumatology, Herlev and Gentofte University Hospital, Hellerup.
authors.forename: Ole Rintek
authors.initials: OR
authors.lastname: Madsen
authors.affiliation: Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark.
authors.forename: Inger Marie
authors.initials: IM
authors.lastname: Jensen Hansen
authors.affiliation: Department of Rheumatology, Herlev and Gentofte University Hospital, Hellerup.
authors.forename: Lene
authors.initials: L
authors.lastname: Dreyer
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D001685:Biological Factors / Q000009:adverse effects*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced / Q000453:epidemiology* / Q000821:virology*; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors
chemical_list: D018501:Antirheumatic Agents; D001685:Biological Factors
keywords: DMARD; adverse events; biological DMARD; cancer; human papilloma virus; immunosuppressive agents; rheumatoid arthritis; virus-associated cancer