Medications for RA Linked to Skin Cancer
Studies Show TNF Blockers May Raise Risk of Nonmelanoma Skin Cancer
Oct. 19, 2009 (Philadelphia) -- People who take immune-disease drugs called
TNF blockers for rheumatoid arthritis should check their bodies regularly for
abnormal growths that can signal skin cancer.
That's the advice of doctors after two new studies showed that patients
treated with TNF blockers have higher rates of skin cancer than patients who
take other disease-modifying anti-rheumatic drugs, or DMARDs.
TNF blockers include Remicade, Enbrel, Humira, Cimzia, and Simponi. They
neutralize a protein, tumor necrosis factor alpha, that is overproduced in
inflammatory diseases like rheumatoid arthritis.
TNF, however, also has a normal function in the body: fighting
cancer. The FDA already requires that TNF-blocking drugs carry a boxed
warning of an increased risk of cancer.
The new studies link the drugs to skin cancer in particular and quantify
"what we already suspected," says Eric Ruderman, MD, a rheumatologist at
Northwestern University who was not involved in the new studies.
Still, experts stress that the overall risk of developing skin cancer is low
and that for most patients with rheumatoid arthritis, the benefits of TNF
blockers outweigh the risks.
"Yes, the findings give us pause, but TNF blockers have helped many patients
ravaged by rheumatoid arthritis to become ambulatory," says Johns Hopkins
rheumatologist Allan Gelber, MD.
Gelber moderated a news conference to discuss the new studies at the annual
meeting of the American College of Rheumatology.
TNF Blockers and Skin Cancer
For the first study, researchers at Washington University in St. Louis
combed the medical records of nearly 17,000 people with rheumatoid arthritis
treated at VA hospitals around the country. About 3,000 of them were
treated with TNF blockers.
Compared with people treated with other DMARDs such as Rheumatrex or Arava,
people taking TNF blockers were 34% more likely to develop nonmelanoma skin
cancer. The drugs were also associated with a slightly higher risk of malignant
The longer a person was on TNF blockers, the greater their risk of
nonmelanoma skin cancer, says Prabha Ranganathan, MD, a rheumatologist at
Men, older patients, and those who took steroids to control their disease
were also at increased risk of developing nonmelanoma skin cancer.
"Older patients with rheumatoid arthritis on anti-TNF therapy need to be
watched closely for the development of skin cancer, especially if they are
male, have been on these treatments for a long time, and have a history of
other cancers," she tells WebMD.
British Study on TNF Blockers
For the second study, British researchers reviewed a national registry that
tracks the progress of people with rheumatoid arthritis.
Taking a TNF-blocking drug appeared to increase the risk of developing
nonmelanoma basal or squamous cell skin cancers by about 70%, compared to
treatment with a traditional DMARD, but the finding could have been due to