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Influence of aromatase inhibitors therapy on the occurrence of rheumatoid arthritis in women with breast cancer: results from a large population-based study of the Italian Society for Rheumatology
  1. Marta Caprioli1,
  2. Greta Carrara2,
  3. Garifallia Sakellariou3,
  4. Ettore Silvagni4 and
  5. Carlo Alberto Scirè2,4
  1. 1Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Italy
  2. 2Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
  3. 3Chair and Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
  4. 4Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
  1. Correspondence to Prof Carlo Alberto Scirè; c.scire{at}reumatologia.it

Abstract

Objectives The purpose of this study was to evaluate the risk of developing rheumatoid arthritis (RA) in a population of patients with breast cancer treated with aromatase inhibitors (AIs) compared with tamoxifen.

Methods Data were collected from the administrative healthcare database of Lombardy Region, Italy, from 2004 to 2013. This study follows a nested cohort design, including women with a diagnosis of breast cancer starting treatment with tamoxifen, anastrozole, exemestane or letrozole. The risk of RA related to the prescription of the different drugs was estimated by survival models for competing risks and the results are presented as hazard ratios (HRs) and 95% confidence intervals (95% CI), adjusted for age and cancer severity.

Results Out of total 10 493 women with breast cancer with a median (IQR) age of 66 (57–74), 7533 (71.8%) started an active treatment with AIs or tamoxifen. In this subgroup a total of 113 new cases of RA developed during the 26 105.9 person-year of 10 186 exposure periods, including time varying exposures in the same patient. Using tamoxifen as reference category, AIs therapy was associated with an increased risk of RA (adjusted HR 1.62 (95%1.03–2.56)), in particular in patients receiving anastrozole, even after adjusting for age and level of neoplasia: (adjusted HR 1.75 (95%1.07–2.86)).

Conclusions In a large population-based sample of women with breast cancer, exposure to AIs compared with tamoxifen is associated with a significantly increased risk of RA, which is not influenced by the cancer severity and the relationship of age with indication to specific drugs.

  • tamoxifene
  • rheumatoid arthritis
  • aromatase inhibitors
  • breast cancer

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/rmdopen-2017-000523

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    Footnotes

    • Contributors Study concept and design: MC, CAS. Data curation and formal analysis: GC. Investigation: CAS. Methodology: GC, CAS. Statistical analysis: GC, CAS, MC. Drafting of the manuscript: MC. Critical revision of the manuscript for important intellectual content: GS, CAS, ES. All the authors were involved in the interpretation of data and have read and approved the final manuscript.

    • Funding This study is supported by the Italian Society for Rheumatology.

    • Competing interests None declared.

    • Ethics approval The access to the data was granted by the General Directorate of Health for the purpose of the RECord linkage on Rheumatic Diseases (RECORD) study protocol of analysis, in accordance with national ethical requirements. The protocol was approved by the local ethical committee of the Pavia University Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data regarding this study have been used for this manuscript only. No other unpublished data from this study are available. These data are available only after specific request to the authors.