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Abstract：
Objectives: To investigate whether there is an elevated neoplasm risk in patients with rheumatic diseases treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Methods: A population-based nested case-control study was performed by retrieving all patients newly diagnosed with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriatic arthritis (PsA) or psoriasis vulgaris (PsO) from the 2000 Longitudinal Health Insurance Database (LHID 2000) in Taiwan. Two hundred and sixty-one patients with neoplasm from 1997 to 2013 were enrolled in this study, and controls were matched in a 1:1 ratio with age, sex, and year of enrollment. Composition of demographic indices, comorbidities, medication usage, and differences in days of prescription of different medications between neoplasm and neoplasm-free (control) groups were compared. Results: Between the control and neoplasm groups, no differences in ratio were observed in the usage of hydroxychloroquine (50.96 vs. 49.04%, p = 0.6616), methotrexate (26.82 vs. 27.59%, p = 0.8441), azathioprine (3.45 vs. 3.07%, p = 0.8052), and cyclophosphamide (1.15 vs. 2.30%, p = 0.3131) from enrollment to index date. Medications within 3 years before the index date in patients that had ≥3 months of comparable duration also showed no difference (hydroxychloroquine: 33.06 vs. 30.25%, p = 0.6404; methotrexate: 20.66 vs. 25.21%, p = 0.4018; azathioprine: 2.48 vs. 2.52%, p = 0.9835; cyclophosphamide: 0.83 vs. 0.84%, p = 0.9906). We also made a subgroup analysis focusing on RA and SLE patients; no difference between control and neoplasm group in both the ratio of usage and days of prescription of hydroxychloroquine, methotrexate, azathioprine, and cyclophosphamide was observed. Conclusion: Neoplasm risk in patients with rheumatic diseases has no correlation with csDMARD usage.
摘要：
目的：研究接受常规合成疾病缓解抗风湿药（csDMARDs）治疗的风湿性疾病患者是否存在肿瘤风险升高。方法：通过检索所有新诊断为类风湿关节炎（RA）的患者，进行基于人群的巢式病例对照研究。系统性红斑狼疮（SLE），以及台湾2000年纵向健康保险数据库（LHID2000）中的银屑病关节炎（PsA）或寻常型银屑病（PsO）。本研究纳入了1997年至2013年的161例肿瘤患者，和对照组以1:1的比例与年龄相匹配，性别,和入学年份。人口指数的构成，合并症,药物使用,并比较了肿瘤组和无肿瘤（对照组）组之间不同药物处方天数的差异。结果：在对照组和肿瘤组之间，在羟氯喹的使用中没有观察到比例差异(50.96vs.49.04%,p=0.6616),甲氨蝶呤（26.82vs.27.59%,p=0.8441)，硫唑嘌呤（3.45vs.3.07%,p=0.8052),和环磷酰胺（1.15vs.2.30%,p=0.3131)从注册到索引日期。在具有≥3个月的相当持续时间的患者中，在指数日期前3年内的药物治疗也没有差异（羟氯喹：33.06vs.30.25％，p=0.6404；甲氨蝶呤：20.66vs.25.21%,p=0.4018；硫唑嘌呤：2.48vs.2.52%,p=0.9835；环磷酰胺：0.83vs.0.84%,p=0.9906)。我们还对RA和SLE患者进行了亚组分析；对照组和肿瘤组在羟氯喹的使用比例和处方天数方面没有差异，甲氨蝶呤,硫唑嘌呤，观察到环磷酰胺。结论：风湿性疾病患者的肿瘤风险与csDMARD的使用无关。
