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Table 1 General characteristics of the studies

From: Risk of non-melanoma skin cancer with biological therapy in common inflammatory diseases: a systemic review and meta-analysis

Study

Country

Data source

Study period

Biologic treatment group

 

None-biologic treatment group

 

Risk estimate (95%CI)

Adjustment

Biologic drugs

Number/ cases

Age (years)

Female (%)

Mean/median treatment duration (years)

Control

Number/cases

Age (years)

Female (%)

Mean/median treatment duration (years)

RA

Dreyer 2013

Denmark

The national Danish DANBIO database

2000–2008

TNFI

3347/42

54.3

73

2.9

Nonbiologic DMARDS

3812/34

61.2

74

2.1

HR,1.10 (0.69–1.76)

Age,gender,calendar time

Wadström 2017

Sweden

The Swedish Rheumatology Quality of Care Register

2006–2015

TNFI

10,760/54

58

74

NR

Conventional systemic DMARDS

46,416/467

64

71

NR

SCC HR,1.09 (0.84–1.42)

Age, gender, start of treatment year, comorbidities, No. of hospitalizations, educational level, days spent in inpatient care

Abatacept

2016/17

61

80

SCC HR,2.15 (1.31–3.52)

Rituximab

3566/24

63

76

SCC HR,1.01 (0.66–1.55)

Tocilizumab

1788/5

59

78

SCC HR,0.93 (0.39–2.21)

Wolfe 2007

USA

US National Data Bank for Rheumatic Diseases

1998–2005

Infliximab

4430/161

58.5

78

2.9

Biologic naïve

NR

58.5

78

NR

OR,1.7 (1.3–2.2)

Age, gender, educational level, smoking history, baseline patient activity scale, baseline prednisone use

Etanercept

3163/126

2.7

OR,1.2 (1.0–1.5)

Adalimumab

812/10

1.2

OR,0.9 (0.5–1.8)

Ozen 2019

USA

US National Data Bank for Rheumatic Diseases

2005–2015

Abatacept

1099/37

61.5

85.5

2.5

Conventional systemic DMARDS

1103/20

63.3

80.9

2

HR,1.05 (0.22- 4.98)

Age, gender, employment status, annual income, education level, smoking status, disease duration, HAQ-Disability Index, pain and patient global scores, BMI, Rheumatic Diseases Comorbidity Index score, any chronic lung disease, diabetes, number of prior bDMARDs, glucocorticoid use, year of study entry, follow-up time

Solomon 2014

USA

Corrona RA registry

2001–2010

TNFI

3761/22

NR

77.7

NR

Methotrexate

1566/17

NR

72.3

NR

HR,0.57 (0.26–1.27)

Age, gender, race, tobacco, alcohol use, BMI, disease duration, serologic status, joint erosions, CDAI, family history of cancer, HAQ, number of past DMARDs used, use of oral glucocorticoids

Abatacept

408/5

NR

84.1

HR,1.85 (0.33–10.43)

Rituximab

167/1

NR

76.7

HR,1.61 (0.09–28.6)

Amari 2011

USA

The Austin Information Technology Center and the pharmacy benefits management

1998–2008

TNFI

4088/283

59.6

9.6

NR

Nonbiologic DMARDS

18,396/1043

63.1

9.4

NR

HR,1.42 (1.24–1.63)

Age, gender, race, comorbid diagnoses

Raaschou 2016

Sweden

The Swedish Biologics Register

1998–2012

BCC TNFI

8827/236

55.3

74.8

4.2

BCC Biologic naïve

43,675/1587

61.6

71.5

4.7

HR,1.14 (0.98–1.33)

Age, gender, birth year, country of birth, county of residency, educational level, comorbidities until start of follow-up (hospital admissions/outpatient visits for chronic obstructive pulmonary disease, ischemic heart disease, diabetes mellitus, knee/hip joint replacement surgery, psoriatic disease)

SCC TNFI

12,558/191

55.2

75.4

5.9

SCC Biologic naïve

46,409/847

60.9

71.5

5.1

HR,1.30 (1.10–1.55)

Mercer 2017

UK

British Society for Rheumatology Biologics Register

2003–2008

TNFI

11,704/BCC 150, SCC 23

56

76

4.01

Nonbiologic DMARDS

3523/BCC 38, SCC 4

60

72

2.65

BCC HR,1.20 (0.83 to 1.73)

SCC HR,1.79 (0.59 to 5.41)

Age,gender

Etanercept

5086/BCC 57

56

77

3.7

BCC,HR,1.07 (0.70 to 1.63)

Infliximab

3663/BCC 59

56

76

2.7

BCC,HR,1.73 (1.14 to 2.62)

Adalimumab

5035/BCC 34

57

76

2.05

BCC,HR,0.89 (0.56 to 1.42)

Haynes 2012

USA

Safety Assessment of Biological Therapeutics

1998–2007

TNFI

19,750/134

NR

85.1

0.5

Methotrexate

9805/77

NR

85.8

0.3

HR,1.07 (0.79–1.46)

Propensity scores calculated according to age, sex, race, residence, nursing home/community dwelling, area income, calendar year, number of hospitalizations, outpatient and emergency room visits, number of different medication classes filled, extraarticular disease manifestations, number of intraarticular and orthopedic procedures, number of laboratory tests ordered for inflammatory markers, chronic obstructive pulmonary disease, diabetes, and use of cancer screening tests

IBD

Haynes 2012

USA

Safety Assessment of Biological Therapeutics

1998–2007

TNFI

2657/14

NR

66.9

NR

Azathioprine or mercaptopurine

3700/30

NR

65.9

NR

HR,0.37 (0.13–1.07)

Propensity scores calculated according to age, sex, race, residence, nursing home/community dwelling, area income, calendar year, number of hospitalizations, outpatient and emergency room visits, number of different medication classes filled, extraarticular disease manifestations, number of intraarticular and orthopedic procedures, number of laboratory tests ordered for inflammatory markers, chronic obstructive pulmonary disease, diabetes, and use of cancer screening tests

Long 2010

USA

PharMetrics Patient-

Centric Database

1996–2005

Adalimumab or Infliximab-recent use

387/14

49.7

47.6

NR

None

1548/36

49.2

47.6

NR

CD,HR,2.47 (1.29–4.73)

Age, gender, geographic region, and duration of follow-up

Adalimumab or Infliximab-persist use

228/7

913/13

CD,HR,3.23 (1.24–8.45)

Psoriasis

Asgari 2017

USA

Kaiser Permanente Northern California health insurance database

1998–2011

Biologics (including adalimumab, etanercept, infliximab, certolizumab, ustekinumab, golimumab, tocilizumab, abatacept, anakinra, and rituximab)

2285/109

47.6

47

5.86

Nonbiologic therapy

3604/251

53.1

51

5.23

NMSC HR, 1.42 (1.12–1.80)

BCC HR, 1.81 (1.23–2.67)

SCC HR,1.23 (0.91–1.66)

Age, gender, race/ethnicity, presence of psoriatic arthritis; prior UV light therapy, BMI, and cigarette use

Kimball 2015

USA

MarketScan commercial and Medicare Supplemental claims database

1995–2011

Etanercept

6856/316

49

45.4

NR

Nonbiologic therapy

5857/353

53

55.9

NR

RR, 1.1 (0.8–1.6)

Age, gender, systemic medication exposure at baseline

Adalimumab

3314/175

49

47.4

RR, 1.2 (0.7–1.9)

Infliximab

1044/51

49

53.5

RR, 1.1 (0.4–2.5)

Haynes 2012

USA

Safety Assessment of Biological Therapeutics

1998–2007

TNFI

563/ < 5

NR

65.2

NR

Methotrexate

735/6

NR

59.6

NR

HR,0.35 (0.04–3.43)

Propensity scores calculated according to age, sex, race, residence, nursing home/community dwelling, area income, calendar year, number of hospitalizations, outpatient and emergency room visits, number of different medication classes filled, extraarticular disease manifestations, number of intraarticular and orthopedic procedures, number of laboratory tests ordered for inflammatory markers, chronic obstructive pulmonary disease, diabetes, and use of cancer screening tests

  1. DMARDs: disease-modifying anti-rheumatic drugs; mHAQ: modified Health Assessment Questionnaire; COPD: chronic obstructive pulmonary disease; BMI: body mass index; CDAI: Clinical Disease Activity Index; CRP: C-reactive protein; DAS28: disease activity score in 28 joints; RDCI: Rheumatic Disease Comorbidity Index score; NR: Not reported