TNF inhibitors linked to skin cancer risk
MedWire News: Patients taking tumor necrosis factor (TNF) inhibitors for rheumatoid arthritis (RA) and related conditions have an increased risk for melanoma and non-melanoma skin cancers, results from a review and meta-analysis confirm.
However, the findings, published in the Annals of Rheumatic Diseases, suggested that the agents were not associated with a general increased risk for malignancy, say Xavier Mariette (Paris-Sud University, France) and co-authors.
The team examined data from 21 articles and eight conference articles examining the risk for malignancy following use of the anti-TNF monoclonal antibodies, infliximab and adalimumab, or etanercept, a fusion protein of a TNF receptor and human immunoglobulin, for RA, psoriatic arthritis, or ankylosing spondylitis.
Data from seven studies were pooled to give an all-site malignancy risk with TNF inhibitor use of 0.95, which was not significant. Two reports indicated that longer exposure to the TNF inhibitors was not associated with greater risk for malignancy.
Pooled data from six studies showed a nonsignificant increased risk for lymphoma of 1.11. In addition, results from two studies of patients with a history of malignancy suggested these patients had an increased risk for a new or recurring tumor that was not altered by TNF inhibitor use.
The researchers comment, however, that the pooled risk results have wide confidence intervals that "do not preclude an effect of treatment on the risk for specific malignancies, and researchers should be encouraged to publish additional analyses to add to the evidence base."
Furthermore, data from two and four studies indicated that patients given TNF inhibitors had a significantly increased risk for both melanoma and non-melanoma skin cancers, with a pooled risk of 1.79 and 1.45, respectively.
The team concludes: "Although the overall data are reassuring, the results must be considered with caution due to the limited duration of follow-up and potential biases discussed above.
"In addition, only very limited data are available for site-specific cancers with the exception of skin cancers, and so do not allow any conclusions to be drawn."
By Lynda Williams