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Erschienen in: Zeitschrift für Rheumatologie 9/2010

01.11.2010 | Leitthema

The risk of malignancies in RA patients treated with biologics

verfasst von: Dr. J. Askling, MD, PhD

Erschienen in: Zeitschrift für Rheumatologie | Ausgabe 9/2010

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Abstract

Ever since biologics were introduced in the treatment of RA around 10 years ago, concerns about their safety profiles, including cancer, have been raised. In the case of cancer, these concerns are based on our incomplete understanding of the full effects of these drugs, or the pathways that they inhibit, and their relation to cancer. Thus, it has been difficult to formulate specific hypotheses regarding what to expect (Which cancer types? In which patients? When?), and it will take time until we feel confident that all relevant risks are well characterized. Through RCT meta-analyses and observational studies including the biologics registers, some data have emerged. So far, but with exceptions both in terms of risks observed and absence of data, the emerging picture is reassuring rather than alarming.
Literatur
1.
Zurück zum Zitat Smitten AL, Simon TA, Hochberg MC, Suissa S (2008) A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis. Arthritis Res Ther 10(2):R45CrossRefPubMed Smitten AL, Simon TA, Hochberg MC, Suissa S (2008) A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis. Arthritis Res Ther 10(2):R45CrossRefPubMed
2.
Zurück zum Zitat Baecklund E, Iliadou A, Askling J et al (2006) Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis. Arthritis Rheum 54(3):692–701CrossRefPubMed Baecklund E, Iliadou A, Askling J et al (2006) Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis. Arthritis Rheum 54(3):692–701CrossRefPubMed
3.
Zurück zum Zitat Hellgren K, Smedby KE, Feltelius N et al (2010) Do rheumatoid arthritis and lymphoma share risk factors? A comparison of lymphoma and cancer risks before and after diagnosis of rheumatoid arthritis. Arthritis Rheum 62(5):1252–1258CrossRefPubMed Hellgren K, Smedby KE, Feltelius N et al (2010) Do rheumatoid arthritis and lymphoma share risk factors? A comparison of lymphoma and cancer risks before and after diagnosis of rheumatoid arthritis. Arthritis Rheum 62(5):1252–1258CrossRefPubMed
4.
Zurück zum Zitat Balkwill F (2006) TNF-alpha in promotion and progression of cancer. Cancer Metastasis Rev 25(3):409–416CrossRefPubMed Balkwill F (2006) TNF-alpha in promotion and progression of cancer. Cancer Metastasis Rev 25(3):409–416CrossRefPubMed
5.
Zurück zum Zitat Askling JF, Nordstrom K, Ross B et al (2010) Cancer risk with tumour necrosis factor alpha (TNF) inhibitors: meta-analysis of randomized controlled trials of adalimumab, etanercept, and infliximab using patient level data. Pharmacoepidemiol Drug Saf. DOI: 10.1002/art.24941 Askling JF, Nordstrom K, Ross B et al (2010) Cancer risk with tumour necrosis factor alpha (TNF) inhibitors: meta-analysis of randomized controlled trials of adalimumab, etanercept, and infliximab using patient level data. Pharmacoepidemiol Drug Saf. DOI: 10.1002/art.24941
6.
Zurück zum Zitat Bongartz T, Sutton AJ, Sweeting MJ et al (2006) Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 295(19):2275–2285CrossRefPubMed Bongartz T, Sutton AJ, Sweeting MJ et al (2006) Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 295(19):2275–2285CrossRefPubMed
7.
Zurück zum Zitat Bongartz T, Warren FC, Mines D et al (2009) Etanercept therapy in rheumatoid arthritis and the risk of malignancies: a systematic review and individual patient data meta-analysis of randomised controlled trials. Ann Rheum Dis 68(7):1177–1183CrossRefPubMed Bongartz T, Warren FC, Mines D et al (2009) Etanercept therapy in rheumatoid arthritis and the risk of malignancies: a systematic review and individual patient data meta-analysis of randomised controlled trials. Ann Rheum Dis 68(7):1177–1183CrossRefPubMed
8.
Zurück zum Zitat Leombruno JP, Einarson TR, Keystone EC (2009) The safety of anti-tumour necrosis factor treatments in rheumatoid arthritis: meta and exposure-adjusted pooled analyses of serious adverse events. Ann Rheum Dis 68(7):1136–1145CrossRefPubMed Leombruno JP, Einarson TR, Keystone EC (2009) The safety of anti-tumour necrosis factor treatments in rheumatoid arthritis: meta and exposure-adjusted pooled analyses of serious adverse events. Ann Rheum Dis 68(7):1136–1145CrossRefPubMed
9.
Zurück zum Zitat Lunt M, Watson KD, Dixon WG et al (2010) No evidence of association between anti-TNF treatment and mortality in patients with rheumatoid arthritis: Results from the British Society for Rheumatology Biologics Register. Arthritis Rheum. DOI 10.1002/art.27660 Lunt M, Watson KD, Dixon WG et al (2010) No evidence of association between anti-TNF treatment and mortality in patients with rheumatoid arthritis: Results from the British Society for Rheumatology Biologics Register. Arthritis Rheum. DOI 10.1002/art.27660
10.
Zurück zum Zitat Strangfeld A, Hierse F, Rau R et al (2010) Risk of incident or recurrent malignancies among patients with rheumatoid arthritis exposed to biologic therapy in the German biologics register RABBIT. Arthritis Res Ther 12(1):R5CrossRefPubMed Strangfeld A, Hierse F, Rau R et al (2010) Risk of incident or recurrent malignancies among patients with rheumatoid arthritis exposed to biologic therapy in the German biologics register RABBIT. Arthritis Res Ther 12(1):R5CrossRefPubMed
11.
Zurück zum Zitat Askling J, Vollenhoven RF van, Granath F et al (2009) Cancer risk in patients with rheumatoid arthritis treated with anti-tumor necrosis factor alpha therapies: does the risk change with the time since start of treatment? Arthritis Rheum 60(11):3180–3189CrossRefPubMed Askling J, Vollenhoven RF van, Granath F et al (2009) Cancer risk in patients with rheumatoid arthritis treated with anti-tumor necrosis factor alpha therapies: does the risk change with the time since start of treatment? Arthritis Rheum 60(11):3180–3189CrossRefPubMed
12.
Zurück zum Zitat Wolfe F, Michaud K (2007) Biologic treatment of rheumatoid arthritis and the risk of malignancy: analyses from a large US observational study. Arthritis Rheum 56(9):2886–2895CrossRefPubMed Wolfe F, Michaud K (2007) Biologic treatment of rheumatoid arthritis and the risk of malignancy: analyses from a large US observational study. Arthritis Rheum 56(9):2886–2895CrossRefPubMed
13.
Zurück zum Zitat Setoguchi S, Solomon DH, Weinblatt ME et al (2006) Tumor necrosis factor alpha antagonist use and cancer in patients with rheumatoid arthritis. Arthritis Rheum 54(9):2757–2764CrossRefPubMed Setoguchi S, Solomon DH, Weinblatt ME et al (2006) Tumor necrosis factor alpha antagonist use and cancer in patients with rheumatoid arthritis. Arthritis Rheum 54(9):2757–2764CrossRefPubMed
14.
Zurück zum Zitat Askling J, Baecklund E, Granath F et al (2009) Anti-tumour necrosis factor therapy in rheumatoid arthritis and risk of malignant lymphomas: relative risks and time trends in the Swedish Biologics Register. Ann Rheum Dis 68(5):648–653CrossRefPubMed Askling J, Baecklund E, Granath F et al (2009) Anti-tumour necrosis factor therapy in rheumatoid arthritis and risk of malignant lymphomas: relative risks and time trends in the Swedish Biologics Register. Ann Rheum Dis 68(5):648–653CrossRefPubMed
15.
Zurück zum Zitat Wolfe F, Michaud K (2007) The effect of methotrexate and anti-tumor necrosis factor therapy on the risk of lymphoma in rheumatoid arthritis in 19,562 patients during 89,710 person–years of observation. Arthritis Rheum 56(5):1433–1439CrossRefPubMed Wolfe F, Michaud K (2007) The effect of methotrexate and anti-tumor necrosis factor therapy on the risk of lymphoma in rheumatoid arthritis in 19,562 patients during 89,710 person–years of observation. Arthritis Rheum 56(5):1433–1439CrossRefPubMed
16.
Zurück zum Zitat Mariette X, Tubach F, Bagheri H et al (2010) Lymphoma in patients treated with anti-TNF: results of the 3-year prospective French RATIO registry. Ann Rheum Dis 69(2):400–408CrossRefPubMed Mariette X, Tubach F, Bagheri H et al (2010) Lymphoma in patients treated with anti-TNF: results of the 3-year prospective French RATIO registry. Ann Rheum Dis 69(2):400–408CrossRefPubMed
17.
Zurück zum Zitat Askling J (2009) group As. ANTI-TNF therapy and risk of skin cancer, data from the Swedish artis registry 1998–2006. EULAR 2009 Askling J (2009) group As. ANTI-TNF therapy and risk of skin cancer, data from the Swedish artis registry 1998–2006. EULAR 2009
18.
Zurück zum Zitat Franklin J, Lunt M, Bunn D et al (2007) Influence of inflammatory polyarthritis on cancer incidence and survival: results from a community-based prospective study. Arthritis Rheum 56(3):790–798CrossRefPubMed Franklin J, Lunt M, Bunn D et al (2007) Influence of inflammatory polyarthritis on cancer incidence and survival: results from a community-based prospective study. Arthritis Rheum 56(3):790–798CrossRefPubMed
19.
Zurück zum Zitat Raaschou P, Askling J, group tAs (2008) Are cancer occurring against a background of anti-TNF particularly aggressive? ACR 2008 Raaschou P, Askling J, group tAs (2008) Are cancer occurring against a background of anti-TNF particularly aggressive? ACR 2008
20.
Zurück zum Zitat Dixon WG, Watson KD, Lunt M et al (2010) Influence of anti-tumor necrosis factor therapy on cancer incidence in patients with rheumatoid arthritis who have had a prior malignancy: results from the British Society for Rheumatology Biologics Register. Arthritis Care Res (Hoboken) 62(6):755–763CrossRef Dixon WG, Watson KD, Lunt M et al (2010) Influence of anti-tumor necrosis factor therapy on cancer incidence in patients with rheumatoid arthritis who have had a prior malignancy: results from the British Society for Rheumatology Biologics Register. Arthritis Care Res (Hoboken) 62(6):755–763CrossRef
21.
Zurück zum Zitat Rennard SI, Fogarty C, Kelsen S et al (2007) The safety and efficacy of infliximab in moderate to severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 175(9):926–934CrossRefPubMed Rennard SI, Fogarty C, Kelsen S et al (2007) The safety and efficacy of infliximab in moderate to severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 175(9):926–934CrossRefPubMed
22.
Zurück zum Zitat Simard J, Neovius M, Hagelberg S, Askling J (2010) Juvenile idiopathic arthritis and risk of cancer: a nationwide cohort study. Arthritis Rheum. DOI: 10.1002/art.27741 Simard J, Neovius M, Hagelberg S, Askling J (2010) Juvenile idiopathic arthritis and risk of cancer: a nationwide cohort study. Arthritis Rheum. DOI: 10.1002/art.27741
Metadaten
Titel
The risk of malignancies in RA patients treated with biologics
verfasst von
Dr. J. Askling, MD, PhD
Publikationsdatum
01.11.2010
Verlag
Springer-Verlag
Erschienen in
Zeitschrift für Rheumatologie / Ausgabe 9/2010
Print ISSN: 0340-1855
Elektronische ISSN: 1435-1250
DOI
https://doi.org/10.1007/s00393-010-0639-8

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