BARCELONA, Spain—A case-control study of 700 patients with lymphoma and rheumatoid arthritis (RA) presented at the 2007 EULAR meeting suggests that treatment with oral steroids for longer than 2 years may decrease the lymphoma risk typically associated with RA, according to lead investigator Eva Baecklund, MD, PhD, with the department of rheumatology at Uppsala University Hospital, in Sweden.1 The risk reduction occurred regardless of when in the course of the disease steroid treatment was initiated.

"Concerns about lymphoma risk should thus not limit long-term treatment with oral steroids."—Eva Baecklund, MD, PhD.
The new findings may help tip the scale in favor of steroid therapy for RA, which doctors have been hesitant to prescribe because of what they perceive as an unfavorable risk-benefit profile.

"The results of this case-control study suggest that oral steroids, irrespective of when during the course of RA they are administered, protect in a dose-response fashion against lymphoma development, in particular for the lymphoma subtype most specifically associated with RA (diffuse large B-cell lymphoma)," Dr. Baecklund said. "Concerns about lymphoma risk should thus not limit long-term treatment with oral steroids."

Findings may ease concerns about steroid risks and benefits in RA

The investigators compared 378 RA patients with lymphoma with 378 age-matched RA controls without lymphoma. They found that total steroid treatment duration longer than 2 years was associated with a markedly reduced lymphoma risk (RR = 0.4, 0.2-0.7), but total steroid treatment duration less than 2 years was not associated with lymphoma risk (RR = 0.9, 0.5-1.5).

Steroids were protective, even if started late in the RA disease process. Oral steroids conferred the greatest protection from diffuse large B-cell lymphoma (OR = 0.7, 0.4-1.0) versus all other subtypes. Steroid treatment was not associated with the presence of Epstein-Barr virus (in situ hybridization) in the lymphomas.

"Patients should be dosed to keep disease activity low," Dr. Baecklund advised.

Still viable after all these years

"Corticosteroids are still an important drug," EULAR President Tore K. Kvien, with Diakonhjemmet Hospital, in Oslo, Norway, told CIAOMed. "For many patients who are intolerant to traditional DMARDs and biologics, corticosteroids are a treatment option for them."
He added that "our focus is to reduce inflammatory activity, and corticosteroids are still and important way to achieve that objective."

Reference

1. Baecklund E, Iliadou A, Hellgren K, et al. Long-term steroid treatment may decrease lymphoma risk in rheumatoid arthritis. Results from a Swedish case-control study of 400 RA-lymphomas. Presented at: EULAR 2007 Meeting; June 13-16, 2007; Barcelona, Spain. Abstract OP0047.