Biologic Therapy for Rheumatoid Arthritis and Risk of Skin Cancer
by Dr. C.H. Weaver M.D. updated 5/2019
Some but not all research studies evaluating the risk of developing skin and other cancers following the use of biologic drugs to treat rheumatoid arthritis and other inflammatory conditions suggest there is an increased risk of developing skin and other cancers.
In 2007 doctors published finding in Arthritis and Rheumatism, that reported that treatment of rheumatoid arthritis with drugs such as Remicade® (infliximab) or Enbrel® (etanercept) may increase the risk of skin cancer but did not appear to increase the risk of other types of cancer.
Among patients with rheumatoid arthritis, the risk of cancer may be influenced not only by the rheumatoid arthritis itself, but also by the drugs used to manage the condition. To explore the effects on cancer risk of a type of rheumatoid arthritis treatment known as biologic therapy, researchers conducted a study among more than 13,000 individuals with rheumatoid arthritis. The risk of cancer among individuals who had used biologic therapy was compared to the risk of cancer among those who had not used biologic therapy.
Biologic therapy drugs included Remicade® (infliximab), Enbrel® (etanercept), Humira® (adalimumab), and Kineret® (anakinra).
- Use of biologic therapy increased the risk of non-melanoma skin cancer (such as basal cell carcinoma or squamous cell carcinoma) by roughly 50%.
- Use of biologic therapy also appeared to increase the risk of melanoma, but this result was not statistically significant; this means that the result could have occurred by chance.
- Risk of other cancers was similar among users and nonusers of biologic therapy.
The researchers conclude that biologic therapy for rheumatoid arthritis may increase the risk of skin cancer but does not appear to increase the risk of other types of cancer.(1)
Remicade® and Humira® May Increase Risk of Cancer
According to an article published in the Journal of the American Medical Association, patients taking the rheumatoid arthritis drugs Remicade® (infliximab) or Humira® (adalimumab) had a three-fold increased risk of developing various types of cancers.(2)
Researchers from the Mayo Clinical conducted a study to further evaluate the potential effects of Remicade and Humira on the incidence of cancer. The study included data from nine clinical trials that compared anti-TNF therapy to placebo (inactive substitute) in patients with rheumatoid arthritis. The studies included over 3,000 persons receiving anti-TNF therapy and over 1,500 receiving placebo (control group).
- Patients taking anti-TNF therapy had over a three-fold increased risk in developing a cancer than the control group.
- Patients treated with high doses of anti-TNF therapy had a 4.3-fold increased risk of developing cancer compared to the control group.
- Patients treated with low doses of anti-TNF therapy had a 1.4-fold increased risk of developing cancer compared to the control group.
- Types of cancers that were increased were lymphomas, skin cancer, breast cancer, lung cancer, and gastrointestinal tract cancers.
- This data represents one additional cancer for every 154 patients treated with anti-TNF therapy.
More recently according to a combined analysis of previous studies, use of biologic drugs for the treatment of rheumatoid arthritis doe not increase the short-term risk of cancer. These results were published in the Journal of the American Medical Association.
To further explore the relationship between biologic DMARDs and cancer risk, researchers combined information from 63 prior clinical trials. These studies enrolled a total of 29,423 patients, and followed patients for at least six months.
- During the clinical trials, cancer was diagnosed in 211 of the more than 29,000 trial participants. These 211 cases involved many different types of cancer.
- Short-term risk of cancer did not vary significantly by type RA treatment: during the first year of treatment, cancer was diagnosed in 0.64% of people treated with a biologic drug alone, 0.77% of people treated with a biologic drug in combination with methotrexate, and 0.66% of people in the comparison groups.
These results suggested that use of biologic DMARDs for the treatment of RA does not increase cancer risk early in the course of treatment.
Patients considering biologic treatment should discuss the risk of associated skin and other cancers with their physician and make sure an appropriate skin cancer monitoring program is in place if they choose to receive biologic therapy.
- Wolfe F, Michaud K. Biologic treatment of rheumatoid arthritis and the risk of malignancy: Analyses from a large U.S. observational study. Arthritis and Rheumatism. 2007;56:2886-2895.
- Bongartz T, Sutton AJ, Sweeting MJ, et al. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serous infections and malignancies. Journal of the American Medical Association. 2006;295:2275-2285.
- Lopez-Olivo MA, Tayar JH, Martinez-Lopez JA et al. Risk of malignancies in patients with rheumatoid arthritis treated with biologic therapy: A meta-analysis. JAMA. 2012;308:898-908.