Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Effect of Disease-Modifying Anti-Rheumatic Drug (DMARD) Exposure on Head and Neck Cancer in a National Cohort of Veterans with Rheumatoid Arthritis.
Phillips2, Christopher R., Zeringue3, Angelique L., McDonald1, Jay R., Eisen3, Seth A., Caplan4, Liron, Ranganathan5, Prabha
Division of Infectious Disease, St. Louis Veterans Affairs Medical Center
Division of Rheumatology, Washington University School of Medicine, Paducah, KY
St. Louis Veterans Affairs Medical Center
Univ of CODenver Med Sc, Aurora, CO
Washington University School of Medicine, St. Louis, MO
A role for virus-induced malignant transformation has been postulated for primary squamous cell carcinoma of the head and neck (HNC). Previous studies have examined the effect of disease-modifying ant-rheumatic drug (DMARD) exposure on the risk of overall malignancy in patients with rheumatoid arthritis (RA). The effect of tumor necrosis factor (TNF) antagonists on the natural history of HNC in RA, which may be detrimental, given the possible viral etiology of these cancers, has not been explored. Our aim was to determine the effect of exposure to TNF antagonists on HNC in terms of incidence, recurrence, and death from HNC in a national cohort of veterans with RA.
We examined a retrospective cohort of 49,539 patients with an International Classification of Disease, Version 9, (ICD-9) diagnosis of RA and at least one DMARD prescription from the Department of Veterans' Affairs (VA) national administrative data bases enrolled between October 1, 1998 and September 30, 2008. Pharmacy data was obtained from national VA databases. Subjects with an ICD-9 code for HNC after entry into the cohort underwent medical record review to confirm the diagnosis of HNC and RA. Details on HNC diagnosis, recurrence, treatment, HNC-related death, and comorbidities were abstracted.
Of 807 patients with an ICD-9 diagnosis of RA and HNC, 255 patients had both RA and HNC after validation by medical record review. Demographic and clinical characteristics of these patients are presented in Table 1. Of these, 65 patients received a TNF antagonist, and 190 received only non-biologic DMARDs. Of the 65 patients exposed to TNF antagonists, 43 were exposed prior to diagnosis of HNC, 20 had continued exposure after diagnosis, and 20 received TNF antagonists only after HNC diagnosis. Of the 255 patients, 201 had HNC remission, 42 had a recurrence or developed a second HNC (at a different site), and 60 had HNC-related death. Of the 40 patients exposed to a TNF antagonist post-HNC diagnosis for whom information was available, 7 developed a recurrence, and 5 had a HNC-related death. The incidence of HNC recurrence and HNC-related death was 27.3 and 18.8 per 1000 patient-years in patients exposed to TNF antagonists after HNC diagnosis compared to 29.3 and 30.3 per 1000 patient-years in patients exposed only to non-biologic DMARDs.
Exposure to TNF antagonists does not appear to increase the risk of HNC recurrence or HNC-related death in patients with RA compared to exposure to non-biologic DMARDs. The use of TNF antagonists may be safe in patients with RA and head and neck cancer with careful monitoring.
|Exposed only to non-biologic DMARDs||Exposed to TNF antagonists|
|Age (std dev)||62.9 (9.1)||64.7 (9.2)|
|Male gender (%)||188 (99.0%)||64 (98.5%)|
|White race (%)||57 (87.7%)||171 (90.0%)|
|Smoker (%)||180 (94.7%)||59 (90.8%)|
|Alcohol Abuse (%)||132 (69.5%)||51 (78.5%)|
|Other Cancers (%)||13 (6.8%)||2 (3.1%)|
To cite this abstract, please use the following information:
Phillips, Christopher R., Zeringue, Angelique L., McDonald, Jay R., Eisen, Seth A., Caplan, Liron, Ranganathan, Prabha; Effect of Disease-Modifying Anti-Rheumatic Drug (DMARD) Exposure on Head and Neck Cancer in a National Cohort of Veterans with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :62