Biological disease-modifying antirheumatic drugs (bDMARDs), including tumor necrosis factor (TNF) inhibitors, do not heighten the risk of malignant lymphomas among patients with rheumatoid arthritis (RA), according to findings from a new study.
“Treatment with bDMARDs, including both TNF inhibitor and non-TNF inhibitor bDMARDs, does not further increase the lymphoma risk in RA; instead, bDMARD treatment may actually reduce the excess lymphoma risk in RA,” the researchers wrote.
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The researchers investigated the link between bDMARDs and lymphoma risk among individuals with RA using nationwide Swedish registers. The study included 16,392 patients with RA initiating treatment with bDMARDs; 55,253 bDMARD-naïve patients with RA; and 229,047 age- and gender-matched general population comparators.
Among patients with RA treated with bDMARDs, the study estimated a lymphoma crude incidence rate of 76 per 100,000 person-years compared with 90 per 100,000 person-years for patients with RA who were bDMARD naïve.
The adjusted hazard ratio of lymphoma associated with bDMARD treatment compared with no bDMARD treatment was 1.08 (95% CI, 0.83-1.41), according to the study. Meanwhile, compared with the general population, the adjusted hazard ratio of lymphoma was 1.65 for patients treated with bDMARDs (95% CI, 1.31-2.08) and 1.56 for patients who were bDMARD naïve (95% CI, 1.37-1.78).
However, when researchers restricted follow-up to after 2006, the adjusted hazard ratio of lymphoma for patients starting a first bDMARD compared with those who were bDMARD-naïve dropped to 0.69 (95% CI, 0.47-1.0). And, compared with patients switching from one conventional synthetic DMARD to another, the adjusted hazard ratio was 0.46 for patients treated with a bDMARD (95% CI, 0.28-0.73).
“There were no signals of different risks with any particular [TNF inhibitor] agent,” according to the researchers. “We found no different lymphoma subtype pattern following bDMARD therapy.”
Hellgren K, Di Giuseppe D, Smedby KE, Sundström C, Askling J, Baecklund E; ARTIS study group. Lymphoma risks in patients with rheumatoid arthritis treated with biological drugs—a Swedish cohort study of risks by time, drug and lymphoma subtype. Rheumatology. Published online August 18, 2020. doi:10.1093/rheumatology/keaa330