NEW YORK (Reuters Health) - When used at the recommended doses, treatment with anti-tumor necrosis factor (anti-TNF) drugs, a relatively new class of drugs for RA treatment does not increase the risk of serious adverse events, according to a report in the Annals of the Rheumatic Diseases.
At high doses, however, anti-TNF agents double the risk of serious infections, the findings suggest.
The findings stem from a review of data from 18 trials identified through a search of MEDLINE and other sources through December 2007. Included in the analysis were 8800 subjects with rheumatoid arthritis and the average follow-up period was 0.8 years.
Treatment with anti-TNF agents at the recommended doses did not significantly increase the risks of death, serious adverse events, serious infection, lymphoma, non-melanoma skin cancers, or non-cutaneous cancers plus melanoma, lead author Dr. J. P. Leombruno, from the University of Toronto, and colleagues note.
By contrast, use of anti-TNF agents at two-to-three times the recommended doses did increase the risk of serious infections. However, further analysis showed that this risk fell as trial duration increased.
SOURCE: Annals of the Rheumatic Diseases for July 2009.
Bumping, because it's nice to end the week with some good news What about those that got Cancer. Ms etc ??? from TNF drugs. Tell them it's safeTreatment with anti-TNF agents at the recommended doses did not significantly increase the risks of death, serious adverse events, serious infection, lymphoma, non-melanoma skin cancers, or non-cutaneous cancers plus melanoma, lead author Dr. J. P. Leombruno, from the University of Toronto, and colleagues note.
Rheumatoid arthritis (RA) is associated with an increased risk for certain cancers, while it decreases the risk for others, results show.
"Because of the immune pathways underlying its pathogenesis and what has generally been an immunosuppressive approach to disease management using traditional disease-modifying anti-rheumatic drugs (DMARDs), the risk of malignancies among RA patients has been of considerable interest," write Samy Suissa (Royal Victoria Hospital, Montreal, Quebec, Canada) and colleagues.
To address these concerns, Suissa and team reviewed all suitable observational studies published between 1990 and 2007 that examined links between RA and malignancy.
Combining data from the 21 relevant studies and comparing it with that from the general population, the authors demonstrated that the risks for lymphoma and lung cancer were significantly increased in patients with RA, with incidence ratios of 2.08 and 1.63, respectively, compared with healthy individuals.
In contrast, patients with RA were significantly less likely to develop colorectal or breast cancer than other individuals, with incidence ratios of 0.77 and 0.84, respectively.
In 13 studies that examined general malignancies, the risk was found to be approximately equal in those with and without RA.
Concluding in the journal Arthritis Research and Therapy, the investigators suggest that "further studies evaluating specific risk factors such as RA management strategies should help provide additional information on the underlying mechanisms for the observed changes in malignancy risk relative to the general population."
In a related editorial, Thorvardur Love and Daniel Solomon from Harvard Medical School in Boston, Massachusetts, USA, agreed on the need for further study, but suggested that the clinical relevance of the current results is unclear. Concluding, Love and Solomon ask whether the findings are significant enough to necessitate separate cancer screening for those with RA.