Elsevier

Lung Cancer

Volume 59, Issue 2, February 2008, Pages 266-269
Lung Cancer

Case report
Lung cancer after exposure to disease modifying anti-rheumatic drugs

https://doi.org/10.1016/j.lungcan.2007.06.013Get rights and content

Summary

Objective

To assess the effects of disease modifying anti-rheumatic drugs (DMARDs) on lung cancer risk in a large rheumatoid arthritis (RA) cohort.

Methods

We assembled a cohort of RA patients (N = 23,810) from population-based administrative healthcare databases. We ascertained cases of lung cancer in the cohort using physician billing and hospitalization records. Each lung cancer case was age and sex matched to 10 controls. We used conditional logistic regression to determine the effects of DMARDs on lung cancer risk, calculating the adjusted rate ratio (RR) attributable to each DMARD.

Results

Subjects were followed for a total of 157,204 person-years. During this time, 960 cases of lung cancer were recorded. The frequency of exposures to various DMARDs was similar in cases and controls; our adjusted RR estimates, reflecting the independent effects of each DMARD exposure, did not associate any of the drugs with an increased risk of lung cancer.

Conclusions

Our data do not suggest that DMARD exposures are the primary mediator of lung cancer risk in RA. An increased risk of lung cancer in RA patients may be related to other determinants, including shared risk factors for the development of both RA and lung cancer.

Section snippets

Methods

We assembled a cohort of RA patients using provincial administrative data from the Régie d’assurance maladie du Québec [RAMQ] physician billing and pharmacy claims databases, and the provincial hospitalization database. The RAMQ and hospitalization databases are linkable through use of provincial health insurance numbers, a 10-digit unique identifier for each beneficiary.

Physician services and inpatient medical care are covered by universal provincial health insurance, but the pharmacy database

Data analysis

Conditional logistic regression was used to estimate, in the nested case-control sample, the rate ratio (RR) for lung cancer related to each DMARD, along with 95% confidence intervals (CIs) for the adjusted estimates. For our analyses we considered DMARD exposures in terms of time-dependent use, aiming to assess the independent effects of the most commonly used types. The adjusted RR estimate reflects the impact of each specific exposure, adjusted for all other medications, as well as

Results

The study cohort included 23,810 RA patients with DMARD exposures and no prior history of cancer. At the time of entry into the cohort, the average age of subjects was 61.7 (standard deviation [S.D.] = 14.6) years. The majority (70.1%) were women, reflecting the typical female predominance in RA. The most commonly used DMARDs at cohort entry included methotrexate, anti-malarial agents, and sulfasalazine.

Subjects were followed for a total of 157,204 person-years (an average of 6.7 years, S.D. 5.1,

Discussion

Though most studies of malignancy in RA have focussed on the risk of hematological malignancy, there is also growing evidence of increased lung cancer risk, both in terms of incidence [1], [8] and mortality [2]. Given the importance of lung cancer in RA, it is somewhat surprising that there has been little effort to establish the etiology of the association.

One potential explanation has been that cancer risk in RA is driven by drug exposures, particularly alkylating agents like

Conflict of interest

None.

Acknowledgements

Sasha Bernatsky is the recipient of career awards from the Canadian Institutes for Health Research (CIHR), Fonds de recherche en santé du Québec (FRSQ), Canadian Arthritis Network, and of support from the McGill University Research Institute and Faculty of Medicine. Ann Clarke is an FRSQ National Scholar. Samy Suissa is the recipient of the James McGill professorship and the CIHR distinguished investigator award. The McGill Pharmacoepidemiology Research Unit is funded by the FRSQ.

References (18)

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