If your looking for review articles with lots of data, check this out from www.medscape.com . (abstract below) They reviewed and analyzed data from a broad array of studies. The conclusions are for the most part encouraging...especially (c), no increased risk for malignant cancer other than some concern for skin cancer risk. I also thought it was interesting that they recommend continual monitoring for TB now (yearly) and say in the article that the TB skin test is not reliable for RA patients. Last month my RD told me they are now giving a yearly TB blood test for RA patients, my first one was last week and was negative.
http://www.medscape.com/viewarticle/568635?src=rss (full article url)
Complications of Anti-TNF Therapies
Posted 01/18/2008
Tina Ding; Chris Deighton
Author Information
Abstract and Introduction
Abstract
Anti-TNF drugs have revolutionized the treatment of rheumatoid arthritis (RA). Concerns about risks of infection and malignancy with these agents have led to scrutiny of available data. Patients with severe, active RA are more prone to infection and lymphoma than the general population, which confounds data interpretation. For both infection and cancer risk the data are contradictory, but suggest a) an increased risk of serious infection (~ twofold), b) that vigilance is required for tuberculosis and other granulomatous and intracellular infection when screening patients, as well as close monitoring thereafter, c) no overall increased cancer risk, but concerns regarding skin cancers, and possible greater risks for patients with prior tumors. Although the advantages of these drugs far outweigh their disadvantages, we cannot be complacent about monitoring patients on anti-TNF closely. Regular updates of analyses of observational databases for emerging problems are needed.
Alan
"Most cases of TB occurred within the first 6 months of anti-TNF therapy and more often present as disseminated, extrapulmonary or atypical mycobacteria compared with the rest of the population. The overwhelming majority have occurred in patients with a known history of TB, suggesting reactivation of latent TB.[66] Risk of developing TB can be minimized by screening for previous exposure and latent TB prior to commencing anti-TNF therapy. Effectiveness of screening was shown in the Spanish register.[72] After introduction of screening recommendations and management of latent TB, the rates for active TB in biologics patients decreased by 78%. Conversely, failing to follow recommendations is associated with a sevenfold increase in the risk of latent infection reactivation.[73] Recommendations vary between countries for TB screening because of different underlying incidence rates, and vaccination prevalences that influence risk of latent TB, and interpretation of screening test results. However, there are notable recurrent themes in recommendations:
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