TNF Inhibitors for RA Do Not Increase Malignancy Risk

But tumor necrosis factor inhibitor exposure ups non-melanoma skin cancer and melanoma risk

MONDAY, Sept. 12 (HealthDay News) -- Treatment of rheumatoid arthritis (RA) with tumor necrosis factor inhibitors (TNFi) does not increase risk of malignancy, including lymphoma, but it may increase the risk of non-melanoma skin cancer and melanoma, according to a meta-analysis published online Sept. 1 in the Annals of Rheumatic Diseases.

Xavier Mariette, from the Université Paris-Sud 11 in Le Kremlin-Bicêtre, France, and colleagues reviewed available literature to investigate the risk of malignancies in patients with RA treated with TNFi. A total of 21 full texts and eight abstracts of prospective, observational studies were included in the analysis.

The investigators found that the pooled estimated risk of all-site malignancy determined from seven studies was 0.95 (95 percent confidence interval [CI], 0.85 to 1.05). Based on two studies, there was no evidence of increased malignancy risk due to longer exposure to TNFi agents. New or recurring malignancies were more likely to occur among those with previous malignancies; although the CI was wide, this risk was not increased further by TNFi exposure. Significantly increased risk of non-melanoma skin cancer due to TNFi exposure was reported by four studies (pooled estimate, 1.45). The pooled estimate from two studies showed an increased risk of developing melanoma (pooled estimate, 1.79; 95 percent CI, 0.92 to 2.67), and the pooled estimate for risk of lymphoma was 1.11 (95 percent CI, 0.70 to 1.51).

"This systematic review and meta-analysis shows that TNFi treatments do not increase the risk of malignancy, particularly lymphoma," the authors write.

All of the study authors disclosed financial relationships with the pharmaceutical industry, including Wyeth Europa, which funded the study.

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