American Academy of Ophthalmology
The use of anti-tumor necrosis factor (anti-TNF) therapy is controversial because some researchers have suggested that it may increase the risk of lymphoma. This is important to ophthalmologists because anti-TNF therapy is increasingly used to treat uveitis. However, in this large epidemiologic study, Wolfe and Michaud found no increase in risk of lymphoma. The study used the National Data Bank for Rheumatic Diseases (NDB) and the National Death Index (NDI). More than 19,000 patients participated in the NDB, completing semiannual questionnaires from 1998 through 2005, for 89,710 person-years of follow-up. Of the total, 55.3 percent received anti-TNF agents and 68 percent received methotrexate (MTX).
The odds ratio for lymphoma in patients who received anti-TNF therapy was 1.0, compared with patients who did not receive anti-TNF therapy. The ratio for patients who received anti-TNF plus MTX was 1.1, compared with patients who received MTX alone. Infliximab and etanercept were considered individually and were not associated with an increased risk of lymphoma.
Prior studies have shown an increased risk of lymphoma with anti-TNF therapy, but they have had methodological problems, according to Wolfe and Michaud. This large study suggests that there is no increased lymphoma risk, and the controversy remains unresolved.