According to a combined analysis of previous studies, use of biologic drugs for the treatment of rheumatoid arthritis (RA) does not increase the short-term risk of cancer. These results were published in the Journal of the American Medical Association.
Rheumatoid arthritis affects an estimated 1.3 million adults in theUnited States. Important advances have been made in the management of RA, and use of more effective drugs earlier in the course of RA has improved outcomes for many patients.
Treatment of RA often begins with methotrexate or another standard disease-modifying antirheumatic drug (DMARD). If this initial treatment does not adequately control the RA, patients may move on to treatment with a newer and more potent type of drug known as a biologic DMARD. These drugs include Remicade® (infliximab), Humira® (adalimumab), Cimzia® (certolizumab), Simponi® (golimumab), Enbrel® (etanercept), Actemra® (tocilizumab), Kineret® (anakinra), Orencia® (abatacept), and Rituxan® (rituximab).
RA is an autoimmune disease, and biologic DMARDs act by interfering with certain aspects of the immune system. These drugs increase the risk of infection, and there’s been concern that they could also increase the risk of certain types of cancer. Studies have produced varying results on this question.
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 suggest that use of biologic DMARDs for the treatment of RA does not increase cancer risk early in the course of treatment. Additional studies will be required to evaluate longer-term risk of cancer, and to evaluate the risk of cancer among RA patients with a history of cancer or with strong risk factors for cancer.
Reference: 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.
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