Lymphoma in patients treated with anti-TNF: results of the 3-year prospective French RATIO registry.

OBJECTIVE: To describe cases of lymphoma associated with anti-TNF therapy, identify risk factors, estimate the incidence and compare the risks for different anti-TNF agents. METHODS: A national prospective registry was designed (Research Axed on Tolerance of bIOtherapies; RATIO) to collect all cases of lymphoma in French patients receiving anti-TNF therapy from 2004 to 2006, whatever the indication. A case-control analysis was conducted including two controls treated with anti-TNF per case and an incidence study of lymphoma with the French population was used as the reference. RESULTS: 38 cases of lymphoma, 31 non-Hodgkin's lymphoma (NHL) (26 B cell and five T cell), five Hodgkin's lymphoma (HL) and two Hodgkin's-like lymphoma were collected. Epstein-Barr virus was detected in both of two Hodgkin's-like lymphoma, three of five HL and one NHL. Patients receiving adalimumab or infliximab had a higher risk than those treated with etanercept: standardised incidence ratio (SIR) 4.1 (2.3-7.1) and 3.6 (2.3-5.6) versus 0.9 (0.4-1.8). The exposure to adalimumab or infliximab versus etanercept was an independent risk factor for lymphoma in the case-control study: odds ratio 4.7 (1.3-17.7) and 4.1 (1.4-12.5), respectively. The sex and age-adjusted incidence rate of lymphoma was 42.1 per 100 000 patient-years. The SIR was 2.4 (95% CI 1.7 to 3.2). CONCLUSION: The two to threefold increased risk of lymphoma in patients receiving anti-TNF therapy is similar to that expected for such patients with severe inflammatory diseases. Some lymphomas associated with immunosuppression may occur, and the risk of lymphoma is higher with monoclonal-antibody therapy than with soluble-receptor therapy.

Keywords

Anti-TNF Lymphoma Safety Rheumatoid arthritis Spondylarthropathies

Domains

Life Sciences [q-bio] Santé publique et épidémiologie

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Article-RATIO-Lymphoma-anti_TNF-ARD-revision_fth.pdf (231.06 Ko)

inserm-00431509_edited.pdf (470.07 Ko)

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https://www.hal.inserm.fr/inserm-00431509

Submitted on : Thursday, November 12, 2009-2:31:10 PM

Last modification on : Thursday, November 17, 2022-4:12:27 AM

Long-term archiving on: Thursday, June 17, 2010-8:11:18 PM

Dates and versions

inserm-00431509 , version 1 (12-11-2009)

Identifiers

HAL Id : inserm-00431509 , version 1
DOI : 10.1136/ard.2009.117762
PUBMED : 19828563

Cite

Xavier Mariette, Florence Tubach, Haleh Bagheri, Michel Bardet, Jean-Marie Berthelot, et al.. Lymphoma in patients treated with anti-TNF: results of the 3-year prospective French RATIO registry.: Lymphoma complicating anti-TNF therapy. Annals of the Rheumatic Diseases, 2010, 69 (2), pp.400-8. ⟨10.1136/ard.2009.117762⟩. ⟨inserm-00431509⟩

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