Uncertainty remains over TNF inhibitors and risk of cancer
Patients receiving tumour necrosis factor (TNF) inhibitors for rheumatoid arthritis are not at substantially greater risk of cancer than those receiving methotrexate, researchers have found. The findings appear to clash with other research suggesting a greater
likelihood of malignancies compared with placebo (PJ, 3 June, p649).
In the recent study (Arthritis & Rheumatism 2006;54:2757), researchers
analysed data from 1,152 patients taking biological disease-modifying
antirheumatic drugs (DMARDs) — TNF inhibitor (etanercept, infliximab
or adalimumab) or interleukin-1 inhibitor (anakinra) — alongside
data from 7,306 patients taking methotrexate. The authors say that patients
taking methotrexate were chosen for the comparison group because the
severity of rheumatoid arthritis would be similar to those receiving
biological DMARDs.
They found that, overall, there was no difference in the risk of cancers
between the two groups (biological DMARD versus methotrexate; adjusted
pooled hazard ratio 0.98, 95 per cent confidence interval 0.73–1.31).
The hazard ratios for lymphoproliferative, haematologic or solid cancers
were 1.11 (CI 0.51–2.37), 1.37 (CI 0.71–2.65) and 0.91 (CI
0.65–1.26), respectively.
The authors say that the results do not rule out an increased risk of
cancers in rheumatoid arthritis patients treated with biological DMARDs
compared with those receiving non-methotrexate DMARDs, or in non-rheumatoid
arthritis patients receiving the agents. They conclude: “Despite
the use of large combined data sets, studying the effect of an infrequent
exposure (biologic DMARDs) on rare diseases (haematologic malignancies)
remains a challenge.” |
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