Rheumatoid Arthritis Drugs May Increase Skin Cancer Risk

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Use of rheumatoid arthritis drugs known as tumor necrosis factor (TNF) inhibitors (e.g., Enbrel, Remicade, others), may increase the risk of skin cancer, including melanoma. The finding comes from a review and meta-analysis of published research on the arthritis medications.

TNF inhibitors pose significant risks

In rheumatoid arthritis, cells called follicular dendritic cells use tentacles to lock onto B cells, which the immune system uses to fight infection and inflammation. These now faulty B cells cannot perform their immune system function and instead play a key role in rheumatoid arthritis.

TNF inhibitors can disrupt the activity of follicular dendritic cells and reduce the number of faulty B cells, which in turn can reduce inflammation and pain associated with rheumatoid arthritis. It also appears TNF inhibitors may increase the risk of skin cancer.

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The researchers used data from 21 studies and eight conference abstracts, which overall provided information concerning more than 40,000 patients equaling nearly 150,000 cumulative years of exposure to TNF inhibitors.

Four of the studies showed that patients who took TNF inhibitors were 45 percent more likely to develop skin cancer other than melanoma. Two studies indicated that people who used TNF inhibitors were 79 percent more likely to develop a melanoma than individuals who did not take these rheumatoid arthritis drugs.

The Food and Drug Administration (FDA) has approved five TNF inhibitors for treatment of rheumatoid arthritis, psoriatic arthritis, and several similar conditions. They include adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi), and infliximab (Remicade). The study discussed here did not include certolizumab and golimumab, which were approved subsequent to the time of the reviewed research.

The authors concluded that the use of TNF inhibitors “does appear to increase the risk of skin cancer, including melanoma.” Patients who use TNF inhibitors for rheumatoid arthritis and other conditions are also at risk for serious infections, as these drugs can compromise the immune system. The FDA has also just issued a warning (on September 7) that use of TNF inhibitors may increase the risk of infection from the bacteria Legionella and Listeria.

SOURCES:
FDA announcement, Sept. 7, 2011
Mariette X et al. Annals of the Rheumatic Diseases 2011; doi: 10.1136/ard.2010.149419

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