Anti-TNF Medications Linked to Higher Risk of Skin Cancer

October 18, 2009

RA patients identified through the Department of Veteran Affairs national administrative databases that were on anti-TNF therapy had a higher risk of developing non-melanoma skin cancer than those on non-biologic DMARDs.

Press Release - American College of Reumatology

An increased risk of non-melanoma skin cancer has been identified among a group of veterans taking anti-TNF therapy for rheumatoid arthritis, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Philadelphia, Pa.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Disease-modifying antirheumatic drugs, or DMARDS as they are commonly called, are often the therapy of choice for patients with RA as they not only reduce inflammation and pain, but can slow the overall progression of the disease. TNF-antagonists (anti-TNF therapy; among drugs called biologics) are a class of drugs that have been used since 1998; overall, they have been given to more than 600,000 people worldwide. These drugs are given to lessen inflammation by interfering with biologic substances that cause or worsen inflammation.

Researchers recently conducted a study to determine the frequency (often called the incidence rate) and risk factors for both non-melanoma (basal and squamous cell) and melanoma skin cancer related to taking non-biologic therapies and anti-TNF therapies among a group of U.S. veterans with RA.

They studied 16,829 patients with RA who had been identified through the Department of Veteran Affairs national administrative databases. The participants were divided into two groups: those treated with non-biologic DMARDs and those treated with anti-TNF DMARDs, and the researchers defined skin cancer as the first occurrence of non-melanoma or melanoma skin cancer after taking a DMARD.

Of the 16,829 patients, 3,096 were on anti-TNF treatment, and the incidence of non-melanoma skin cancer was 25.9 per 1,000 people each year and the incidence of melanoma skin cancer was 3.7 per 1,000 people each year among this group. The incidence rate of non-melanoma skin cancer for those taking non-biologic DMARDs was 19.6 per 1,000 people each year and 2.6 per 1,000 people each year for melanoma.

Researchers concluded that those patients on anti-TNF therapy had a higher risk of developing non-melanoma skin cancer than those on non-biologic DMARDs. Factors that increased this risk were older age, male gender, steroid use, a history of prior malignancies and the duration of time spent on anti-TNF therapy.

“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,” explains Prabha Ranganathan MD, MS; assistant professor of medicine, division of rheumatology, Washington University School of Medicine, St. Louis, Mo., and lead investigator in the study.

“Our results are more robust for non-melanoma compared to melanoma skin cancer as we found the diagnosis codes for non-melanoma skin cancer to be more accurate in the administrative database compared to those for melanoma.”

The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR’s annual meeting, see www.rheumatology.org/annual.

Editor’s Notes: Dr. Ranganathan will present this research during the ACR Annual Scientific Meeting at the Pennsylvania Convention Center from 9 - 11 AM on Tuesday,

Source: American College of Reumatology