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Cancer Risk Higher for Kids With Arthritis

Study: Medications Used to Treat Condition Likely Not to Blame
WebMD Health News
Reviewed by Louise Chang, MD

Feb. 13, 2012 -- Children with juvenile arthritis develop cancer four times more often than children without the disease, but the treatments they receive -- including biologic treatments like Enbrel -- may not explain their increased risk, according to a new study.

If confirmed, researchers say the findings should ease fears that biologic treatments known as TNF inhibitors cause cancer in children and young adults.

But the study also raises new concerns about cancer risk linked to the rheumatic diseases for which the drugs are prescribed.

Cancer Concerns for Biologics Not New

Soon after the first TNF inhibitors became available almost 15 years ago, anecdotal reports of cancers in users of the drugs began surfacing.

Reports of malignancies in nearly 50 children prompted the FDA to require TNF-inhibitor manufacturers to include a “black box” warning on their labeling, alerting users about a possible cancer risk.

Last November, the agency announced that it would also require those manufacturers to perform “enhanced safety surveillance” on the drugs when used in children and adults under 30.

The newly reported study is among the largest ever to examine cancers in children with juvenile idiopathic arthritis (JIA), a disease that afflicts close to 300,000 children and teens in the U.S.

By analyzing Medicaid records from 2000 to 2005, researchers from the University of Alabama, Birmingham (UAB), identified 7,812 children with JIA. Their analysis also included comparison to more than 650,000 kids with asthma and close to 322,000 with attention deficit hyperactivity disorder (ADHD).

Compared to children without JIA, children with the rheumatic disease had a 4.4-times greater cancer risk. Treatment with a TNF inhibitor did not appear to influence this risk. The main TNF inhibitor reported used by children in the JIA group was Enbrel.

The study appears online in the journal Arthritis & Rheumatism.

Disease, Not Drugs, Raises Cancer Risk?

Cautioning that the results are preliminary, researcher and UAB associate professor of pediatrics Timothy Beukelman, MD, says the findings do not support the conclusion that TNF inhibitors are strongly linked to cancer.

He says a similar study from Sweden, which found a two- to three-fold greater cancer risk in JIA patients, came to a similar conclusion.

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