Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:Along with increased proportions of patients using methotrexate (MTX) and biological agents (from 34.2% and 0.0% in 2000 to 77.3% and 18.8% in 2013, respectively), the proportions with DAS28 remission and low disease activity increased from 8.4% and 13.8% in 2000 to 54.7% and 20.8% in 2013, respectively, based on our observational cohort of Japanese patients with RA, the Institute of Rheumatology, Rheumatoid Arthritis (IORRA). Trends for malignancies in patients with RA have not been examined comprehensively in a specific cohort. The aim of this study is to investigate the trends in the occurrence of overall and site-specific malignancies in Japanese patients with RA over a long period.
Methods:Among Japanese patients with RA enrolled in the IORRA, all malignancies occurring from April 2000 to September 2013 were extracted from self-reported information and confirmed by medical records. Malignancies occurring in patients who dropped out of the IORRA study during the subsequent 3 months were also collected by follow-up mailings and medical information from affiliated hospitals. For malignancies overall and at frequently involved sites (breast, malignant lymphoma, stomach, lung, colorectal), the standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) during 3 periods (pre-biologics, 2000-2003; early biologics, 2004-2007; and late biologics, 2008-2011) were calculated based on data from the general Japanese population.
Results:Among 11,106 Japanese patients with RA (68,483 person-years), 507 malignancies (72 breast cancers, 68 malignant lymphomas, 65 stomach cancers, 60 lung cancers, 54 colorectal cancers) were confirmed. The incidence of overall malignancies decreased gradually, with SIRs (95% CIs) of 0.96 (0.80-1.14) in pre-biologics, 0.95 (0.80-1.11) in early biologics and 0.91 (0.79-1.05) in late biologics, respectively (P for trend = 0.43 by Poisson regression). The lung cancer incidence decreased to a level comparable to that of the general Japanese population, with SIRs (95% CIs) of 1.68 (1.07-2.53), 0.60 (0.29-1.10) and 0.97 (0.60-1.48), respectively. The incidence of malignant lymphoma was markedly increased, with SIRs (95% CIs) of 4.53 (2.59-7.35), 4.06 (2.36-6.50) and 4.59 (3.00-6.72), respectively.
Conclusion:Trends in the occurrence of overall and site-specific malignancies in Japanese patients with RA did not increase with the expanding use of MTX and biological agents in this decade.
|Malignancy||Pre-biologics (2000-2003) (Male, 3,376 pys; Female, 16,171 pys)||Early biologics (2004-2007) (Male, 3,482 pys; Female, 17,682 pys)||Late biologics (2008-2011) (Male, 3,502 pys; Female, 19,015 pys)|
|SIR (95% CI)||SIR (95% CI)||SIR (95% CI)|
|Total||0.96 (0.80-1.14)||0.95 (0.80-1.11)||0.91 (0.79-1.05)|
|Breast||0.61 (0.30-1.09)||1.37 (0.95-1.92)||0.64 (0.40-0.97)|
|Malignant lymphoma||4.53 (2.59-7.35)||4.06 (2.36-6.50)||4.59 (3.00-6.72)|
|Stomach||0.95 (0.57-1.48)||0.90 (0.55-1.38)||0.81 (0.50-1.25)|
|Lung||1.68 (1.07-2.53)||0.60 (0.29-1.10)||0.97 (0.60-1.48)|
|Colorectal||0.44 (0.21-0.81)||0.66 (0.39-1.04)||0.68 (0.43-1.02)|
pys: person-years; SIR: standardized incidence ratio; CI: confidence interval
To cite this abstract in AMA style:Sugimoto N, Tanaka E, Inoue E, Ochiai M, Shimizu Y, Yamaguchi R, Shidara K, Nakajima A, Taniguchi A, Yamanaka H. Trends in the Occurrence of Malignancy in Japanese Patients with Rheumatoid Arthritis Based on the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) Cohort during a 14-Year Observation Period [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/trends-in-the-occurrence-of-malignancy-in-japanese-patients-with-rheumatoid-arthritis-based-on-the-institute-of-rheumatology-rheumatoid-arthritis-iorra-cohort-during-a-14-year-observation-period/. Accessed December 14, 2019.
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