Do RA Drugs Cause Cancer?

Years ago, some early research found that certain rheumatoid arthritis (RA) drugs, especially ones called biologics, might make you more likely to get cancer. But a number of recent studies show that in general, this isn’t the case.

RA itself increases your odds of getting some types of cancer, like lymphoma. Scientists looked into whether RA drugs play a role in that increased risk. They found that chronic inflammation, not medication, is probably to blame. Some biologics may even keep cancer at bay because they keep inflammation in check.

The drugs at the heart of the cancer question are usually biologics. But scientists have also studied the possible link between cancer and disease-modifying antirheumatic drugs (DMARDs).

Anti-TNF Drugs and Cancer

These drugs, which are sometimes called TNF inhibitors or TNF blockers, are biologics like:

Recent studies show they may slightly raise your chance of getting nonmelanoma skin cancers. But they don’t seem to change the odds for other cancers.

One large study compared the risk of lymphoma for people with RA who took either anti-TNFs or non-biologic drugs. Researchers found no link between the drugs and cancer.

Another found that taking anti-TNFs was linked to a lower risk of cancer than taking DMARDs alone. You might have a slightly higher chance of getting blood cancer, but not much.

Researchers also checked the link between anti-TNFs and melanoma, the most lethal form of skin cancer. Once again, they found no connection.

Other Biologics and Cancer

Anti-TNFs aren’t the only biologics to be singled out as a possible cause of cancer if you have RA. One analysis also looked for a link between cancer and other biologics, like:

The study focused on nearly 30,000 people with RA. Researchers found there wasn’t much of an increased risk of cancer from biologics. If you take anakinra plus methotrexate, a DMARD, you’re less likely to get cancer than if you take methotrexate alone.

Another study gives reassurance if you have RA and a history of cancer. Scientists looked at whether anti-TNFs or rituximab boosted cancer cases. The good news: The drugs don’t seem to raise your odds of getting cancer again.

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DMARDs and Cancer Risk

Methotrexate is often the first treatment given to people with RA. But it could make you more likely to get some cancers, especially skin cancer.

One study found methotrexate may be tied to melanoma, non-Hodgkin's lymphoma, and lung cancer. A second found that if you have RA and had a nonmelanoma growth in the past, you might have a greater chance of getting nonmelanoma skin cancer. The risk may be even higher if you take methotrexate with a TNF inhibitor.

Two other DMARDs that are sometimes used to treat RA -- cyclophosphamide and azathioprine -- may also be tied to certain cancers.

What’s the Bottom Line?

Don’t let fear of cancer stop you from taking the RA treatment your doctor suggests, especially given the benefits these drugs offer. DMARDs and biologics can ease painful symptoms and help prevent joint and organ damage. They may even put your disease in remission -- no signs or symptoms of inflammation.

If you’re concerned about cancer, let your doctor know what’s on your mind. Be sure to ask about the pros and cons of taking a recommended drug, as well as the risks and benefits of not taking it.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on September 17, 2019

Sources

SOURCES:

Arthritis Foundation: “Arthritis and Cancer Risk,” “Rheumatoid Arthritis Treatment.”

Annals of the Rheumatic Diseases: “Risk of Lymphoma in Patients Exposed to Antitumour Necrosis

Factor Therapy: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis,” “Risk of Invasive Melanoma in Patients with Rheumatoid Arthritis Treated with Biologics.”

American College of Rheumatology: “Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo),” “TNF Inhibitors.”

Medscape: “Anti-TNF Medications Linked to Nonmelanoma Skin Cancer in Rheumatoid Arthritis Patients,” “Biologics and Cancer Risk in RA: A Treatment Guide.”

Arthritis Research & Therapy: “The Risk of Cancer in Patients with Rheumatoid Arthritis Taking Tumor Necrosis Factor Antagonists: a nationwide cohort study.”

JAMA: “Risk of malignancies in patients with rheumatoid arthritis treated with biologic therapy: a meta-analysis.”

Rheumatology: “The Incidence of Cancer in Patients with Rheumatoid Arthritis and a Prior Malignancy Who Receive TNF Inhibitors or Rituximab: results from the British Society for Rheumatology Biologics Register-Rheumatoid Arthritis.”

Arthritis & Rheumatology: “Incidence of Melanoma and Other Malignancies Among Rheumatoid Arthritis Patients Treated with Methotrexate.”  

JAMA Dermatology: “Risk of Nonmelanoma Skin Cancer Associated With the Use of Immunosuppressant and Biologic Agents in Patients With a History of Autoimmune Disease and Nonmelanoma Skin Cancer.”

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