Biologic therapy for rheumatoid arthritis not significantly linked with increased malignancy risk
Although there are concerns regarding the potential development of malignancies in patients with rheumatoid arthritis who are receiving treatment with biologic response modifiers (BRMs), pooled results from more than 60 randomized controlled trials did not find a statistically significant increased risk of any type of cancer with use of BRMs for at least 6 months compared with traditional disease-modifying antirheumatic drugs or with placebo, according to the results of a meta-analysis published in the September 5 issue of JAMA.
"Rheumatoid arthritis (RA) is a systemic inflammatory polyarthritis that can lead to significant morbidity, joint deformity, and impaired quality of life and affects approximately 1 percent of the general population. Treatment with traditional disease-modifying antirheumatic drugs (DMARDs) reduces disease activity, retards joint destruction, and improves patients' quality of life. However, in many patients with active disease, traditional DMARDs fail or are not tolerated. Biologic response modifiers provide clinically important improvement in patients not responding to traditional DMARDs by targeting specific immune pathways, reducing inflammation, and leading to better control of symptoms and structural damage. In 2010, published data from European and U.S. registries reported that 25 percent to 56 percent of patients with RA used BRMs," according to background information in the article.
The authors add that because these biologic agents interfere with the immune system, concerns exist regarding their safety, specifically with respect to infections and malignancies. "Since 2005, conflicting data have existed associating tumor necrosis factor (TNF) inhibitors with an increased risk of developing certain types of malignancies."
Maria A. Lopez-Olivo, M.D., Ph.D., of the University of Texas MD Anderson Cancer Center, Houston, and colleagues conducted a study to evaluate the risk of developing any type of malignancy in patients with RA receiving treatment with BRMs. The authors searched the medical literature to identify randomized controlled trials that included the BRMs abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab. Studies were selected that compared the safety of any BRMs used in RA patients with placebo and/or any traditional DMARDs with a minimum of 24 weeks of follow-up.
The researchers identified 63 RCTs with 29,423 patients for inclusion in the analysis. No statistically significant increased risk of developing malignancy was observed. Of the 29,423 patients, 211 developed a malignancy during the trial (0.72 percent): 23 of 3,615 patients in the BRM monotherapy group (0.64 percent), 123 of 15,989 patients in the BRM combination therapy group (0.77 percent), and 65 of 9,819 patients in the control group (0.66 percent).
"Of the 211 malignancies, 118 were solid tumors (i.e., adrenal, bladder, breast, cholangiocarcinoma, fibrosarcoma, gastrointestinal, hepatic, leiomyosarcoma, liposarcoma, lung, ovarian, pancreatic, prostate, renal, testicular, thyroid, tongue, uterine), 48 were skin cancers (i.e., basal cell, squamous cell, and 4 melanomas), 14 were lymphomas, 26 were not specified, and 5 were hematologic nonlymphoma (i.e., multiple myeloma, leukemia)," the authors write.
No statistically significant risk was observed for specific cancer sites. Anakinra plus methotrexate showed lower odds compared with methotrexate alone.
"Overall, our findings do not support an increased risk of malignancy for patients with RA receiving BRMs in RCTs of at least 24 weeks' duration. Additional systematic reviews of observational studies are needed to establish risk in the longer term. Although the findings suggest that BRMs may be generally safe with respect to risk of malignancy in the short term, the risk of recurrence in patients with RA with history of cancer or cancer risk factors remains unknown," the authors conclude.
More information: JAMA. 2012;308:898-908
Journal reference: Journal of the American Medical Association
Provided by JAMA and Archives Journals
- Biologic treatment for rheumatoid arthritis and the risk of cancer Aug 29, 2007 | not rated yet | 0
- Common rheumatoid arthritis and psoriasis medications are associated with reduced diabetes risk Jun 21, 2011 | not rated yet | 0
- ACR updates guidelines for use of DMARDs and biologic drugs in treating rheumatoid arthritis Apr 02, 2012 | not rated yet | 0
- Rituximab combined with a TNF inhibitor and methotrexate shows no safety signal in RA treatment Mar 08, 2011 | not rated yet | 0
- DMARDs, glucocorticoids and biologics equally effective for rheumatoid arthritis Sep 28, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Calculating Steam Pressure in Closed Container
3 hours ago I am trying to calculate the volume of liquid water i need to place in a sealed container in order to obtain 10 psi of steam pressure in that closed...
Learning curve of Electromagnetism?
9 hours ago I'm taking a first year physics course and have been having a little trouble with the basics of newtons laws and forces and whatnot, though nothing...
thin glass in liquid
10 hours ago I have one question about optics because I start interested in it. If an object is placed a distance p from a thin glass lens (index of refraction...
How many joules expended for a push up?
13 hours ago Just wondering if any of you can do the calculation that well approximates the amount of joules expended by a push up.
force to keep the folding doors
13 hours ago Hello, I would like to ask you to calculate the force F, which needed to keep the folding doors in this position. I would like to know what is the...
Confusion regarding direction of kinetic friction on inclined plane.
14 hours ago *please help! * The formula for kinetic friction acting on a sliding body is μkN When the body is sliding with constant velocity down an...
- More from Physics Forums - Classical Physics
More news stories
(HealthDay)—Compared to clinical diagnosis of synovitis, ultrasound-detected synovitis provides either improved sensitivity or specificity when used with the American College of Rheumatology/European League ...
Arthritis & Rheumatism May 15, 2013 | not rated yet | 0
(HealthDay)—A genome-wide linkage scan has identified the chromosome 17p11.2-q11.2 region as the susceptibility locus for fibromyalgia, according to research published in the April issue of Arthritis & ...
Arthritis & Rheumatism May 11, 2013 | not rated yet | 0
Scientists have discovered that fat cells in the knee secrete a protein linked to arthritis, a finding that paves the way for new gene therapies that could offer relief and mobility to millions worldwide.
Arthritis & Rheumatism May 08, 2013 | 5 / 5 (5) | 0 |
Researchers from the Royal College of Surgeons in Ireland (RCSI) have discovered that a new treatment for the inflammatory condition, Systemic Lupus Erythmstosus (SLE) could potentially benefit Irish patients who suffer from ...
Arthritis & Rheumatism May 07, 2013 | not rated yet | 0
A team of researchers led by a Boston University Biomedical Engineer has developed a new joint lubricant that could bring longer lasting relief to millions of osteoarthritis sufferers. The new synthetic polymer supplements ...
Arthritis & Rheumatism May 02, 2013 | 4 / 5 (1) | 0
An increasing number of U.S. children are experiencing gastrointestinal issues that require interventions to resolve, according to research presented at Digestive Disease Week (DDW).
12 hours ago | not rated yet | 0 |
The latest makeover to a massive psychiatric tome honored by some, reviled by others and even called the "Bible" of mental disorders is being released Saturday with a host of new changes.
10 hours ago | not rated yet | 0
A new case of the deadly coronavirus has been detected in Saudi Arabia where 15 people have already died after contracting it, the health ministry announced on Saturday on its Internet website.
10 hours ago | not rated yet | 0
Big names in medicine are set to give an upbeat assessment of the war on AIDS on Tuesday, 30 years after French researchers identified the virus that causes the disease.
21 hours ago | 5 / 5 (1) | 0
For combat veterans suffering from post-traumatic stress disorder, 'fear circuitry' in the brain never rests
Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or ...
22 hours ago | 5 / 5 (1) | 0 |
A ground-breaking advance in colonoscopy technology signals the future of colorectal care, according to research presented today at Digestive Disease Week(DDW). Additional research focuses on optimizing the minimal withdrawal ...
12 hours ago | 5 / 5 (2) | 0