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

Xavier Mariette 1 Florence Tubach 2, * Haleh Bagheri 3 Michel Bardet 4 Jean-Marie Berthelot 5 Philippe Gaudin 6 Denis Heresbach 7 Antoine Martin 8 Thierry Schaeverbeke 9 Dominique Salmon 10 Marc Lemann 11 Olivier Hermine 12 Martine Raphael 13 Philippe Ravaud 2
* Auteur correspondant
1 Service de rhumatologie
2 Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques
3 Unité de Pharmacoépidémiologie : Evaluation de l'exposition et du risque médicamenteux
4 Service de médecine interne et rhumatologie
5 Service de Rhumatologie
6 Service de Rhumatologie
7 Service de Gastroentérologie
8 Service de Rhumatologie
9 Service de rhumatologie
10 Service de médecine interne et centre de référence des maladies rares [CHU Cochin]
11 Service de gastro-entérologie
12 Service d'immuno-hématologie pédiatrique [CHU Necker]
13 Laboratoire d'Hématologie
Abstract : 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
Type de document :
Article dans une revue
Annals of the Rheumatic Diseases, BMJ Publishing Group, 2010, 69 (2), pp.400-8. 〈10.1136/ard.2009.117762〉
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Soumis le : jeudi 12 novembre 2009 - 14:31:10
Dernière modification le : vendredi 16 novembre 2018 - 01:12:52
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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, BMJ Publishing Group, 2010, 69 (2), pp.400-8. 〈10.1136/ard.2009.117762〉. 〈inserm-00431509〉

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