Risk of malignancies using anti-TNF agents in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: a systematic review and meta-analysis

Abstract

Malignancies have been reported in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, treated with anti-tumour necrosis factor (anti-TNF) agents. Areas covered: We conducted a systematic review of randomized controlled trials (RCTs) to determine the effect of anti-TNF agents on the occurrence of cancer (any type). Literature databases were searched up to May 2014 to identify relevant studies that evaluated adalimumab, certolizumab, etanercept, golimumab, or infliximab, compared with placebo or no treatment. Data on cancer occurrence were extracted at the maximum follow-up time reported. Expert opinion: Fifty-five RCTs with 20,631 patients met the eligibility criteria. Of these, 32 trials with 15,539 patients reported at least one case of cancer, for a total of 112 malignancies. The degree of variability between studies was consistent with what would be expected to occur by chance alone. There was no evidence of an association between anti-TNF agents and cancer risk (fixed-effects model (OR: 1.31, 95% CI: 0.89, 1.95); a random-effects model (OR: 1.16, 95% CI: 0.75, 1.81)). We found evidence of selective outcome reporting or publication bias suggesting that the pooled effect estimate for cancer may have been overestimated. The evidence is imprecise, and the risk of bias was high or unclear across primary studies.

Immune rebalancing by oral immunotherapy: A novel method for getting the immune system back on track

“…Malignancies have also been reported in patients with RA, psoriatic arthritis, and ankylosing spondylitis that were treated with anti‐anti‐TNF agents . A meta‐analysis of 55 RCTs containing 20,631 patients reported a total of 112 malignancies (0.54%) . Similarly, there is evidence that there is a dose‐dependent risk of malignancy in patients with RA who were treated with anti‐TNF therapy .…”

The Safety Profile of Tumor Necrosis Factor Inhibitors in Ankylosing Spondylitis: Are TNF Inhibitors Safer Than We Thought?

“…All studies to date indicate no increase in the overall and specific site risks of cancer after TNF inhibitors in patients with ankylosing spondylitis. Meta‐analyses of randomized controlled trials show no increased risk of overall cancers in TNF inhibitors treated patients with ankylosing spondylitis . No safety signal was found in a disproportionality analysis of the French pharmacovigilance database .…”

“…Available data on malignancy occurrence in patients with ankylosing spondylitis treated with TNF inhibitors are presented in Table . All studies to date indicate no increase in the overall and specific site risks of cancer after TNF inhibitors in patients with ankylosing spondylitis.…”

Unexpected reason of hip pain in a spondyloarthropathic case

“…Ancak son y›llardaki meta-analizler anti-TNF ilaçlar›n bu grup hastalarda beklenen malignite riskine ek bir katk› sa¤lamad›-¤› yönündedir. [10,11] ‹mmunsupresif tedavi almakta olan hastalarda özellikle bel ve kalça a¤r›s› geliflti¤inde ay›r›c› tan›ya giren spinal enfeksiyonlar grubu önemli bir yer iflgal etmektedir. Vertebra korpusu, intervertebral disk, spinal kanal ve paravertebral dokulardaki enfeksiyonlar hem nadir görülmekte-dirler hem de gürültülü bir klinik tablo yapmad›kça sessiz seyredebilmektedirler.…”