How comparable are rates of malignancies in patients with rheumatoid arthritis across the world? A comparison of cancer rates, and means to optimise their comparability, in five RA registries

Johan Askling, Niklas Berglind, Stefan Franzen, Thomas Frisell, Christopher Garwood, Jeffrey D. Greenberg, Meilien Ho, Marie Holmqvist, Laura Horne, Eisuke Inoue, Kaleb D Michaud, Fredrik Nyberg, Dimitrios A. Pappas, George Reed, Eiichi Tanaka, Trung N. Tran, Suzanne M M Verstappen, Hisashi Yamanaka, Eveline Wesby van Swaay, Deborah Symmons

Research output: Contribution to journalArticle

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Abstract

Background The overall incidence of cancer in patients with rheumatoid arthritis (RA) is modestly elevated. The extent to which cancer rates in RA vary across clinical cohorts and patient subsets, as defined by disease activity or treatment is less known but critical for understanding the safety of existing and new antirheumatic therapies. We investigated comparability of, and means to harmonise, malignancy rates in five RA registries from four continents. Methods Participating RA registries were Consortium of Rheumatology Researchers of North America (CORRONA) (USA), Swedish Rheumatology Quality of Care Register (SRR) (Sweden), Norfolk Arthritis Register (NOAR) (UK), CORRONA International (several countries) and Institute of Rheumatology, Rheumatoid Arthritis (IORRA) (Japan). Within each registry, we analysed a main cohort of all patients with RA from January 2000 to last available data, and sensitivity analyses of subcohorts defined by disease activity, treatment change, prior comorbidities and restricted by calendar time or follow-up, respectively. Malignancy rates with 95% CIs were estimated, and standardised for age and sex, based on the distributions from a typical RA clinical trial programme population (fostamatinib). Results There was a high consistency in rates for overall malignancy excluding non-melanoma skin cancer (NMSC), for malignant lymphomas, but not for all skin cancers, across registries, in particular following age/sex standardisation. Standardised rates of overall malignancy excluding NMSC varied from 0.56 to 0.87 per 100 person-years. Within each registry, rates were generally consistent across sensitivity analyses, which differed little from the main analysis. Conclusion In real-world RA populations, rates of both overall malignancy and of lymphomas are consistent.

Original languageEnglish (US)
JournalAnnals of the Rheumatic Diseases
DOIs
StateAccepted/In press - Nov 30 2015

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Registries
Rheumatoid Arthritis
Skin
Rheumatology
Neoplasms
Skin Neoplasms
North America
Standardization
Lymphoma
Research Personnel
Population Control
Quality of Health Care
Sweden
Arthritis
Comorbidity
Japan
Therapeutics
Clinical Trials
Safety
Incidence

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Allergy

Cite this

How comparable are rates of malignancies in patients with rheumatoid arthritis across the world? A comparison of cancer rates, and means to optimise their comparability, in five RA registries. / Askling, Johan; Berglind, Niklas; Franzen, Stefan; Frisell, Thomas; Garwood, Christopher; Greenberg, Jeffrey D.; Ho, Meilien; Holmqvist, Marie; Horne, Laura; Inoue, Eisuke; Michaud, Kaleb D; Nyberg, Fredrik; Pappas, Dimitrios A.; Reed, George; Tanaka, Eiichi; Tran, Trung N.; Verstappen, Suzanne M M; Yamanaka, Hisashi; Swaay, Eveline Wesby van; Symmons, Deborah.

In: Annals of the Rheumatic Diseases, 30.11.2015.

Research output: Contribution to journalArticle

Askling, J, Berglind, N, Franzen, S, Frisell, T, Garwood, C, Greenberg, JD, Ho, M, Holmqvist, M, Horne, L, Inoue, E, Michaud, KD, Nyberg, F, Pappas, DA, Reed, G, Tanaka, E, Tran, TN, Verstappen, SMM, Yamanaka, H, Swaay, EWV & Symmons, D 2015, 'How comparable are rates of malignancies in patients with rheumatoid arthritis across the world? A comparison of cancer rates, and means to optimise their comparability, in five RA registries', Annals of the Rheumatic Diseases. https://doi.org/10.1136/annrheumdis-2015-208105
Askling, Johan ; Berglind, Niklas ; Franzen, Stefan ; Frisell, Thomas ; Garwood, Christopher ; Greenberg, Jeffrey D. ; Ho, Meilien ; Holmqvist, Marie ; Horne, Laura ; Inoue, Eisuke ; Michaud, Kaleb D ; Nyberg, Fredrik ; Pappas, Dimitrios A. ; Reed, George ; Tanaka, Eiichi ; Tran, Trung N. ; Verstappen, Suzanne M M ; Yamanaka, Hisashi ; Swaay, Eveline Wesby van ; Symmons, Deborah. / How comparable are rates of malignancies in patients with rheumatoid arthritis across the world? A comparison of cancer rates, and means to optimise their comparability, in five RA registries. In: Annals of the Rheumatic Diseases. 2015.
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title = "How comparable are rates of malignancies in patients with rheumatoid arthritis across the world? A comparison of cancer rates, and means to optimise their comparability, in five RA registries",
abstract = "Background The overall incidence of cancer in patients with rheumatoid arthritis (RA) is modestly elevated. The extent to which cancer rates in RA vary across clinical cohorts and patient subsets, as defined by disease activity or treatment is less known but critical for understanding the safety of existing and new antirheumatic therapies. We investigated comparability of, and means to harmonise, malignancy rates in five RA registries from four continents. Methods Participating RA registries were Consortium of Rheumatology Researchers of North America (CORRONA) (USA), Swedish Rheumatology Quality of Care Register (SRR) (Sweden), Norfolk Arthritis Register (NOAR) (UK), CORRONA International (several countries) and Institute of Rheumatology, Rheumatoid Arthritis (IORRA) (Japan). Within each registry, we analysed a main cohort of all patients with RA from January 2000 to last available data, and sensitivity analyses of subcohorts defined by disease activity, treatment change, prior comorbidities and restricted by calendar time or follow-up, respectively. Malignancy rates with 95{\%} CIs were estimated, and standardised for age and sex, based on the distributions from a typical RA clinical trial programme population (fostamatinib). Results There was a high consistency in rates for overall malignancy excluding non-melanoma skin cancer (NMSC), for malignant lymphomas, but not for all skin cancers, across registries, in particular following age/sex standardisation. Standardised rates of overall malignancy excluding NMSC varied from 0.56 to 0.87 per 100 person-years. Within each registry, rates were generally consistent across sensitivity analyses, which differed little from the main analysis. Conclusion In real-world RA populations, rates of both overall malignancy and of lymphomas are consistent.",
author = "Johan Askling and Niklas Berglind and Stefan Franzen and Thomas Frisell and Christopher Garwood and Greenberg, {Jeffrey D.} and Meilien Ho and Marie Holmqvist and Laura Horne and Eisuke Inoue and Michaud, {Kaleb D} and Fredrik Nyberg and Pappas, {Dimitrios A.} and George Reed and Eiichi Tanaka and Tran, {Trung N.} and Verstappen, {Suzanne M M} and Hisashi Yamanaka and Swaay, {Eveline Wesby van} and Deborah Symmons",
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T1 - How comparable are rates of malignancies in patients with rheumatoid arthritis across the world? A comparison of cancer rates, and means to optimise their comparability, in five RA registries

AU - Askling, Johan

AU - Berglind, Niklas

AU - Franzen, Stefan

AU - Frisell, Thomas

AU - Garwood, Christopher

AU - Greenberg, Jeffrey D.

AU - Ho, Meilien

AU - Holmqvist, Marie

AU - Horne, Laura

AU - Inoue, Eisuke

AU - Michaud, Kaleb D

AU - Nyberg, Fredrik

AU - Pappas, Dimitrios A.

AU - Reed, George

AU - Tanaka, Eiichi

AU - Tran, Trung N.

AU - Verstappen, Suzanne M M

AU - Yamanaka, Hisashi

AU - Swaay, Eveline Wesby van

AU - Symmons, Deborah

PY - 2015/11/30

Y1 - 2015/11/30

N2 - Background The overall incidence of cancer in patients with rheumatoid arthritis (RA) is modestly elevated. The extent to which cancer rates in RA vary across clinical cohorts and patient subsets, as defined by disease activity or treatment is less known but critical for understanding the safety of existing and new antirheumatic therapies. We investigated comparability of, and means to harmonise, malignancy rates in five RA registries from four continents. Methods Participating RA registries were Consortium of Rheumatology Researchers of North America (CORRONA) (USA), Swedish Rheumatology Quality of Care Register (SRR) (Sweden), Norfolk Arthritis Register (NOAR) (UK), CORRONA International (several countries) and Institute of Rheumatology, Rheumatoid Arthritis (IORRA) (Japan). Within each registry, we analysed a main cohort of all patients with RA from January 2000 to last available data, and sensitivity analyses of subcohorts defined by disease activity, treatment change, prior comorbidities and restricted by calendar time or follow-up, respectively. Malignancy rates with 95% CIs were estimated, and standardised for age and sex, based on the distributions from a typical RA clinical trial programme population (fostamatinib). Results There was a high consistency in rates for overall malignancy excluding non-melanoma skin cancer (NMSC), for malignant lymphomas, but not for all skin cancers, across registries, in particular following age/sex standardisation. Standardised rates of overall malignancy excluding NMSC varied from 0.56 to 0.87 per 100 person-years. Within each registry, rates were generally consistent across sensitivity analyses, which differed little from the main analysis. Conclusion In real-world RA populations, rates of both overall malignancy and of lymphomas are consistent.

AB - Background The overall incidence of cancer in patients with rheumatoid arthritis (RA) is modestly elevated. The extent to which cancer rates in RA vary across clinical cohorts and patient subsets, as defined by disease activity or treatment is less known but critical for understanding the safety of existing and new antirheumatic therapies. We investigated comparability of, and means to harmonise, malignancy rates in five RA registries from four continents. Methods Participating RA registries were Consortium of Rheumatology Researchers of North America (CORRONA) (USA), Swedish Rheumatology Quality of Care Register (SRR) (Sweden), Norfolk Arthritis Register (NOAR) (UK), CORRONA International (several countries) and Institute of Rheumatology, Rheumatoid Arthritis (IORRA) (Japan). Within each registry, we analysed a main cohort of all patients with RA from January 2000 to last available data, and sensitivity analyses of subcohorts defined by disease activity, treatment change, prior comorbidities and restricted by calendar time or follow-up, respectively. Malignancy rates with 95% CIs were estimated, and standardised for age and sex, based on the distributions from a typical RA clinical trial programme population (fostamatinib). Results There was a high consistency in rates for overall malignancy excluding non-melanoma skin cancer (NMSC), for malignant lymphomas, but not for all skin cancers, across registries, in particular following age/sex standardisation. Standardised rates of overall malignancy excluding NMSC varied from 0.56 to 0.87 per 100 person-years. Within each registry, rates were generally consistent across sensitivity analyses, which differed little from the main analysis. Conclusion In real-world RA populations, rates of both overall malignancy and of lymphomas are consistent.

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