title: Incidence of Malignancies in a Cohort of Psoriatic Arthritis Patients Taking Traditional Disease Modifying Antirheumatic Drug and Tumor Necrosis Factor Inhibitor Therapy: An Observational Study.
abstract: Psoriatic arthritis (PsA) is an inflammatory arthropathy, associated with skin and/or nail psoriasis. As suggested in 2012 by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), studies devoted to assess cancer in the PsA population are still limited and need to be increased. Therefore, the aim of this study was to determine the incidence of malignancies in patients with PsA who are taking conventional and biologic therapies.
  
  
  
  A cohort of patients with PsA was followed prospectively. At first visit, as well as at each 3-4 month followup visit, according to standardized clinical practice, medical history, and physical and laboratory findings were recorded. Information on the presence of comorbidities, as well as malignancies, was collected. At each visit, data were recorded on radiography and pathology, confirming malignancy diagnosis, when present.
  
  
  
  A total of 618 patients with PsA were included in the study. In particular, 296 were taking anti-tumor necrosis factor-α (anti-TNF) agents and 322 were taking disease-modifying antirheumatic drugs (DMARD). During the observation period, in the total group, 44 patients (7.1%) had a diagnosis of malignancy. Of them, 14 (4.7%; 95% CI 2.8-7.8; 0.52/100 patient-yrs) received anti-TNF therapy and 30 (9.3%; 95% CI 6.6-13.0; 1.03/100 patient-yrs) received traditional DMARD (p = 0.019). However, after adjusting for major demographic and clinical characteristics, the difference between the 2 treatments was no longer significant (p = 0.480), and the only predictor of malignancy occurrence was age (HR 1.04, 95% CI 1.009-1.073, p = 0.012).
  
  
  
  Data from this study confirm that biological therapies do not lead to any increased risk for cancer development, when adequately administered and with proper followup.
authors.affiliation: From the Rheumatology Unit, Department of Clinical Medicine and Surgery, and the Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.|L. Costa, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; F. Caso, MD, PhD, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; A. Del Puente, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; M.N. Di Minno, MD, PhD, Assistant Professor, Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II; R. Peluso, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, PhD, Associate Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II.
authors.forename: Luisa
authors.initials: L
authors.lastname: Costa
authors.affiliation: From the Rheumatology Unit, Department of Clinical Medicine and Surgery, and the Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.|L. Costa, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; F. Caso, MD, PhD, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; A. Del Puente, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; M.N. Di Minno, MD, PhD, Assistant Professor, Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II; R. Peluso, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, PhD, Associate Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II.
authors.forename: Francesco
authors.initials: F
authors.lastname: Caso
authors.affiliation: From the Rheumatology Unit, Department of Clinical Medicine and Surgery, and the Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.|L. Costa, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; F. Caso, MD, PhD, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; A. Del Puente, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; M.N. Di Minno, MD, PhD, Assistant Professor, Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II; R. Peluso, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, PhD, Associate Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II.
authors.forename: Antonio
authors.initials: A
authors.lastname: Del Puente
authors.affiliation: From the Rheumatology Unit, Department of Clinical Medicine and Surgery, and the Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.|L. Costa, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; F. Caso, MD, PhD, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; A. Del Puente, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; M.N. Di Minno, MD, PhD, Assistant Professor, Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II; R. Peluso, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, PhD, Associate Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II.
authors.forename: Matteo Nicola Dario
authors.initials: MN
authors.lastname: Di Minno
authors.affiliation: From the Rheumatology Unit, Department of Clinical Medicine and Surgery, and the Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.|L. Costa, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; F. Caso, MD, PhD, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; A. Del Puente, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; M.N. Di Minno, MD, PhD, Assistant Professor, Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II; R. Peluso, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, PhD, Associate Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II.
authors.forename: Rosario
authors.initials: R
authors.lastname: Peluso
authors.affiliation: From the Rheumatology Unit, Department of Clinical Medicine and Surgery, and the Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy. rscarpa@unina.it.|L. Costa, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; F. Caso, MD, PhD, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; A. Del Puente, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; M.N. Di Minno, MD, PhD, Assistant Professor, Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II; R. Peluso, MD, PhD, Assistant Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II; R. Scarpa, MD, PhD, Associate Professor, Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II. rscarpa@unina.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Scarpa
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: MALIGNANCIES; PSORIATIC ARTHRITIS; TRADITIONAL DMARD; TUMOR NECROSIS FACTOR INHIBITORS