Comparison between rheumatoid arthritis with malignant lymphoma and other malignancies: Analysis of a National Database of Rheumatic Disease in Japan

Mizushima, M; Sugihara, T; Matsui, T; Urata, Y; Tohma, S; Kawahata, K

doi:10.1016/j.semarthrit.2023.152301

Rheumatoid arthritis

Comparison between rheumatoid arthritis with malignant lymphoma and other malignancies: Analysis of a National Database of Rheumatic Disease in Japan

Semin Arthritis RheumPublished 3 Nov 2023Retrospective cohort study

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Authors' conclusion

Patients receiving long-term treatment with MTX and NSAIDs may be at a relatively high risk of developing ML.

Study context

Population: Rheumatoid arthritis (RA) patients with new-onset malignancies, National Database of Rheumatic Disease in Japan, 2012–2018 (mean age 70.5)cohorts of 597 and 490
Participants: 935 patients

Exposure: RA with malignant lymphoma vs RA with other malignancies
Outcome: Factors associated with development of ML vs other malignancies
Follow-up: 1 year before malignancy

Methodological detailsnational database, multiple logistic regression

National database
Multiple logistic regression

Main finding

As reported in the abstract

Factors associated with ML vs other malignancies (multivariable)

ML vs Other malignanciesOdds ratio (95% CI)P value

MTX use

2.22(1.32–3.73)

P = 0.003

NSAID use

2.51(1.58–3.98)

P < 0.001

Observational data: associations, not effects.

Further findings

Drug use 1 year before malignancy (cohort 1)

MTX

ML74.4%

Other malignancies56.8%

bDMARDs

ML23.4%

Other malignancies25.4%

NSAIDs

ML56.7%

Other malignancies35.3%

CDAI remission · year 1

ML37.3%

Other malignancies31.1%

Outcome	ML	Other malignancies
MTX use 1 year after malignancy (cohort 2)	0 events	41.8%

Proportion with malignant lymphoma (ML) among all malignancies

ML among malignancies: 15.5%
Lung cancer among malignancies: 14.3%

Drug use 1 year before malignancy (cohort 1)

Clinical disease activity index (CDAI) and CRP similar between the two groups

Methotrexate (MTX) use 1 year after malignancy (cohort 2)

In both groups ≈15% received biological disease-modifying anti-rheumatic drugs (bDMARDs) and 50% GC
IL-6 inhibitors preferentially prescribed in ML vs other malignancies

Original publication

Comparison between rheumatoid arthritis with malignant lymphoma and other malignancies: Analysis of a National Database of Rheumatic Disease in Japan. Semin Arthritis Rheum. Published 3 November 2023. doi:10.1016/j.semarthrit.2023.152301

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