Biologics for RA treatment don't increase cancer risk

Biologic response modifiers developed for the treatment of rheumatoid arthritis do not appear to be associated with an increased risk of cancer, according to a study published September 5 in the Journal of the American Medical Association.

Maria A. Lopez-Olivo, MD, PhD, of the University of Texas M.D. Anderson Cancer Center in Houston and colleagues conducted a large systematic review and meta-analysis to examine the risk of developing cancer. They reviewed data for nearly 3,000 rheumatoid arthritis patients being treated with biologic response modifiers (BRMs), such as tumor necrosis factor (TNF) inhibitors, who were enrolled in 63 randomized controlled trials.

Because these biologic agents interfere with the immune system, concerns have been expressed about their safety, specifically with respect to infections and malignancies. However, data linking these treatments with potential cancer risks is not definitive.

The authors found no statistically significant risk for malignancies among patients taking BRMs when compared with patients using other treatments. Of the 29,423 patients, 211 developed a malignancy during the trial. The incidence rate for any malignancy during the first year of therapy was very low in the BRM plus methotrexate group (0.77%; 95% CI, 0.65%–0.92%), the BRM monotherapy group (0.64%; 95% CI, 0.42%–0.95%), and the controls (0.66%; 95% CI, 0.52%–0.84%). Anakinra plus methotrexate showed lower odds compared with methotrexate alone (Peto odds ratio, 0.11; 95% CI, 0.03–0.45), according to the abstract.

“Patients are understandably concerned when treatments are linked to cancer risk. With this knowledge, clinicians can effectively demonstrate that the benefits of BRMs far outweigh the risk,” said Maria E. Suarez-Almazor, MD, professor in the department of general internal medicine, in an Anderson news release.

The authors concluded that further studies need to look at long-term risk and risk of recurrence in patients with RA with history of cancer or cancer risk factors, which remain unknown.