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Mariette X, Tubach F, Bagheri H et al.

 Ann Rheum Dis 2010;69:400–8.

The effect of immunosuppressive drugs such as tumor necrosis factor (TNF) blocking agents can best be gleaned from registries in which there are controls available for comparison with cases. In the present national prospective registry from France, a two- to three-fold increased risk of lymphoma was observed in patients receiving anti-TNF therapy, regardless of the indication. This risk was found to be similar to that expected for patients with severe inflammatory diseases. Interestingly, the risk observed for monoclonal antibody therapy was higher than that with soluble receptor therapy.


In France, a national, prospective registry (RATIO [Research Axed on Tolerance of Biotherapies]) collects data on all cases of lymphoma in patients receiving anti-tumor necrosis factor (anti-TNF) therapy irrespective of the indication. Overall, 38 cases of lymphoma, 31 non-Hodgkin lymphoma (NHL; 26 B cell and five T cell), five Hodgkin lymphoma (HL), and two Hodgkin-like lymphoma were identified between 2004 and 2006. Epstein–Barr virus was present in the two Hodgkin-like lymphoma cases, three of the five HL cases, and one of the NHL cases. Patients treated with adalimumab or infliximab had a higher risk of lymphoma (standardized incidence ratio of approximately 4) than those treated with etanercept (standardized incidence ratio of approximately 1). In line with this observation, the exposure to adalimumab or infliximab versus etanercept yielded a four-fold increase in the development of lymphoma.

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