title: The incidence of cancer in patients with rheumatoid arthritis and a prior malignancy who receive TNF inhibitors or rituximab: results from the British Society for Rheumatology Biologics Register-Rheumatoid Arthritis.
abstract: OBJECTIVE
  To explore the influence of TNF inhibitor (TNFi) therapy and rituximab (RTX) upon the incidence of cancer in patients with RA and prior malignancy.
  
  
  METHODS
  The study population comprised RA subjects with a prior malignancy reported to the UK national cancer registers, recruited to the British Society for Rheumatology Biologics Register from 2001 to 2013. We compared rates of first incident malignancy in a TNFi cohort, RTX cohort and synthetic DMARDs (sDMARD) cohort.
  
  
  RESULTS
  We identified 425 patients with a prior malignancy from 18 000 RA patients in the study. Of these, 101 patients developed a new malignancy. The rates of incident malignancy were 33.3 events/1000 person-years (py) in the TNFi cohort, 24.7 events/1000 py in the RTX cohort and 53.8 events/1000 py in the sDMARD cohort. The age- and gender-adjusted hazard ratio was 0.55 (95% CI: 0.35, 0.86) for the TNFi cohort and 0.43 (95% CI: 0.10, 1.80) for the RTX cohort in comparison with the sDMARDs cohort. The 17.0% of patients in the sDMARDs cohort had a recurrence of the same cancer in comparison with the 12.8% and the 4.3% in the TNFi and RTX cohorts, respectively.
  
  
  CONCLUSIONS
  Although numbers are still low, it seems that patients with RA and prior malignancy selected to receive either a TNFi or RTX in the UK do not have an increased risk of future incident malignancy.
authors.affiliation: Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK.|Rheumatology Department, Complexo Hospitalario Universitario de Ferrol, Ferrol, Spain.
authors.forename: Lucía
authors.initials: L
authors.lastname: Silva-Fernández
authors.affiliation: Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Lunt
authors.affiliation: Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK.
authors.forename: Lianne
authors.initials: L
authors.lastname: Kearsley-Fleet
authors.affiliation: Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK.
authors.forename: Kath D
authors.initials: KD
authors.lastname: Watson
authors.affiliation: Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK.|NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK.
authors.forename: William G
authors.initials: WG
authors.lastname: Dixon
authors.affiliation: Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK.
authors.forename: Deborah P M
authors.initials: DP
authors.lastname: Symmons
authors.affiliation: Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK kimme.hyrich@manchester.ac.uk.|NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK.
authors.forename: Kimme L
authors.initials: KL
authors.lastname: Hyrich
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D001688:Biological Products / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000139:chemically induced; D009369:Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D000069283:Rituximab / Q000009:adverse effects*; D000079424:Tumor Necrosis Factor Inhibitors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D000079424:Tumor Necrosis Factor Inhibitors; D000069283:Rituximab
keywords: anti-TNF; cancer; cohort study; rheumatoid arthritis; rituximab