TNF Blockers Do Not Raise Cancer Risk
NEW YORK (Reuters Health) Sept 27 - Although rheumatoid arthritis (RA) is associated with an increased risk of hematopoietic malignancies, tumor necrosis factor (TNF) antagonists used in the treatment of RA do not appear to raise the risk of lymphoma or solid tumors, Swedish investigators report.
Much of the data regarding cancer risk in RA patients are relatively old, Dr. Johan Askling, from Karolinska University Hospital in Stockholm, and colleagues note in two reports, both published in the October issue of the Annals of The Rheumatic Diseases. There has been evidence that TNF blockers raise the risk of lymphoma, but to assess the risk of cancer associated with these drugs, contemporary and comparable data on the expected incidence in RA are required.
Dr. Askling's group therefore assessed cancer risk in three groups of RA patients: a prevalence cohort of 53,067 subjects diagnosed with RA between 1990 and 2003, an incidence cohort of 3703 patients (<1 year from RA onset), and a TNF antagonist cohort of 4160 patients treated with etanercept, infliximab, or adalimumab between 1999 and 2003.
Through linkage to the Swedish Cancer Register 1964-2003, the authors observed the standardized incidence ratio (SIR) for lymphoma was 1.9 in the prevalence cohort and 2.0 in the incident cohort. The corresponding SIRs for leukemia were 2.1 and 2.2, respectively.
When compared with the lymphoma incidence in the prevalence and incident RA cohorts, the adjusted relative risk of lymphoma in the TNF antagonist cohort was 1.1. This "marginally augmented lymphoma risk...must be judged in the light of a higher disease activity among patients who are offered TNF antagonist treatment," the authors note.
"The extent to which the increased leukemia risk is caused by the RA itself, its treatment, or both, remains unknown," they add.
In the second paper, Dr. Askling's group analyzed the same patient cohorts for the incidence of solid tumors.
Overall, the SIR for solid cancer was 1.05 in the prevalence cohort and 1.1 in the incidence cohort. The risk appeared to be greater in men, largely because of a decreased risk of breast cancer.
The SIR among patients treated with TNF antagonists was 0.9.
The gastrointestinal cancer risk was marginally reduced in the prevalent cohort (SIR = 0.85), and slightly increased in the TNF-antagonist cohort (SIR = 1.2).
"Our results suggest that TNF antagonists as actually used in practice are not associated with a cancer pattern that differs from that of other patients with RA," the authors conclude, "although the non-decreased colorectal cancer occurrence may be a concern."
Ann Rheum Dis 2005;64:1414-1426.
Much of the data regarding cancer risk in RA patients are relatively old, Dr. Johan Askling, from Karolinska University Hospital in Stockholm, and colleagues note in two reports, both published in the October issue of the Annals of The Rheumatic Diseases. There has been evidence that TNF blockers raise the risk of lymphoma, but to assess the risk of cancer associated with these drugs, contemporary and comparable data on the expected incidence in RA are required.
Dr. Askling's group therefore assessed cancer risk in three groups of RA patients: a prevalence cohort of 53,067 subjects diagnosed with RA between 1990 and 2003, an incidence cohort of 3703 patients (<1 year from RA onset), and a TNF antagonist cohort of 4160 patients treated with etanercept, infliximab, or adalimumab between 1999 and 2003.
Through linkage to the Swedish Cancer Register 1964-2003, the authors observed the standardized incidence ratio (SIR) for lymphoma was 1.9 in the prevalence cohort and 2.0 in the incident cohort. The corresponding SIRs for leukemia were 2.1 and 2.2, respectively.
When compared with the lymphoma incidence in the prevalence and incident RA cohorts, the adjusted relative risk of lymphoma in the TNF antagonist cohort was 1.1. This "marginally augmented lymphoma risk...must be judged in the light of a higher disease activity among patients who are offered TNF antagonist treatment," the authors note.
"The extent to which the increased leukemia risk is caused by the RA itself, its treatment, or both, remains unknown," they add.
In the second paper, Dr. Askling's group analyzed the same patient cohorts for the incidence of solid tumors.
Overall, the SIR for solid cancer was 1.05 in the prevalence cohort and 1.1 in the incidence cohort. The risk appeared to be greater in men, largely because of a decreased risk of breast cancer.
The SIR among patients treated with TNF antagonists was 0.9.
The gastrointestinal cancer risk was marginally reduced in the prevalent cohort (SIR = 0.85), and slightly increased in the TNF-antagonist cohort (SIR = 1.2).
"Our results suggest that TNF antagonists as actually used in practice are not associated with a cancer pattern that differs from that of other patients with RA," the authors conclude, "although the non-decreased colorectal cancer occurrence may be a concern."
Ann Rheum Dis 2005;64:1414-1426.
posted by Ricardo Pocurull at 8:56 AM
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