Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists.
From Biocritique.com
The goal of this study was to determine the cancer pattern of patients with rheumatoid arthritis (RA) from both prevalent and incident RA cohorts and understand the risk of solid cancer after treatment with tumor necrosis factor (TNF) inhibitors. The investigators took a population based study of 3 RA cohorts (1 prevalent), admitted to the hospital 1990 – 2003 (N=53,060), 1 incident, diagnosed 1995 – 2003 (N=3,703), and one treated with TNF antagonists from 1999 – 2003 (N=4,116), which were linked to a Swedish nationwide cancer registry and followed up for cancer occurrence through 2003. The main conclusions from this study were that the cancer pattern in patients treated with TNF antagonists is very similar to those of other contemporary as well as historic RA cohorts. The consistent increase in smoking-associated cancers in patients with RA emphasizes the potential for smoking cessation as a cancer preventative measure in RA. In essence, the author’s report that these cohorts, 3,339 cancers observed in the prevalent RA cohort was at largely increased overall risk of solid cancer with 20% - 50% increase risk for smoke-related cancer and a 70% increase risk for non-melanoma skin cancer. However, there was a decreased risk for breast and colorectal cancer of 20% and 25%, respectively. This report from Sweden is timely in that it helps us address one of our unanswered questions regarding the long-term risk of malignancy in patients treated with TNF antagonists. It provides data that there is no increased risk of malignancy due to TNF antagonists. Of note, these data demonstrate a significant decreased risk for breast and colorectal cancer in RA patients. These data provide provocative hypothesis as to the potential reasons for the decrease in colorectal cancer might be attributable to non-steroidal anti-inflammatory drugs, as these are used as one of the mainstay therapies for RA. This type of registry and detailed information from large cohorts of patients will be critical to evaluate the increased risk, if any, of perhaps uncommon but yet clinically significant adverse risks involved in other new therapies over the next several years. This data is reassuring that to date there has been no confirmatory data to suggest any serious problem with long-term risk of increased malignancies in patients who have been treated with anti-TNF therapies. --Larry Moreland, MD
Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists.
J Askling, CM Fored, L Brandt, E Baecklund, L Bertilsson, N Feltelius, L Cöster, P Geborek, LT Jacobsson, S Lindblad, J Lysholm, S Rantapää-Dahlqvist, T Saxne, L Klareskog
Ann Rheum Dis 2005 10;64(10):1421-6
The goal of this study was to determine the cancer pattern of patients with rheumatoid arthritis (RA) from both prevalent and incident RA cohorts and understand the risk of solid cancer after treatment with tumor necrosis factor (TNF) inhibitors. The investigators took a population based study of 3 RA cohorts (1 prevalent), admitted to the hospital 1990 – 2003 (N=53,060), 1 incident, diagnosed 1995 – 2003 (N=3,703), and one treated with TNF antagonists from 1999 – 2003 (N=4,116), which were linked to a Swedish nationwide cancer registry and followed up for cancer occurrence through 2003. The main conclusions from this study were that the cancer pattern in patients treated with TNF antagonists is very similar to those of other contemporary as well as historic RA cohorts. The consistent increase in smoking-associated cancers in patients with RA emphasizes the potential for smoking cessation as a cancer preventative measure in RA. In essence, the author’s report that these cohorts, 3,339 cancers observed in the prevalent RA cohort was at largely increased overall risk of solid cancer with 20% - 50% increase risk for smoke-related cancer and a 70% increase risk for non-melanoma skin cancer. However, there was a decreased risk for breast and colorectal cancer of 20% and 25%, respectively. This report from Sweden is timely in that it helps us address one of our unanswered questions regarding the long-term risk of malignancy in patients treated with TNF antagonists. It provides data that there is no increased risk of malignancy due to TNF antagonists. Of note, these data demonstrate a significant decreased risk for breast and colorectal cancer in RA patients. These data provide provocative hypothesis as to the potential reasons for the decrease in colorectal cancer might be attributable to non-steroidal anti-inflammatory drugs, as these are used as one of the mainstay therapies for RA. This type of registry and detailed information from large cohorts of patients will be critical to evaluate the increased risk, if any, of perhaps uncommon but yet clinically significant adverse risks involved in other new therapies over the next several years. This data is reassuring that to date there has been no confirmatory data to suggest any serious problem with long-term risk of increased malignancies in patients who have been treated with anti-TNF therapies. --Larry Moreland, MD
Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists.
J Askling, CM Fored, L Brandt, E Baecklund, L Bertilsson, N Feltelius, L Cöster, P Geborek, LT Jacobsson, S Lindblad, J Lysholm, S Rantapää-Dahlqvist, T Saxne, L Klareskog
Ann Rheum Dis 2005 10;64(10):1421-6
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