The influence of anti-TNF therapy upon incidence of keratinocyte skin cancer in patients with rheumatoid arthritis: longitudinal results from the British Society for Rheumatology Biologics Register

Abstract

ObjectivesTo compare the risk of keratinoctye skin cancer (basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)) in patients treated for rheumatoid arthritis (RA) compared with the general population, and to determine whether anti-tumour necrosis factor (TNF) therapy exacerbates this risk.MethodsPatients with RA enrolled in the British Society for Rheumatology Biologics Register, a prospective national cohort established in 2001 to monitor the safety of anti-TNF, were followed until 2008. 11 881 patients treated with anti-TNF were compared with 3629 patients receiving non-biological disease-modifying antirheumatic drugs (nbDMARD). Standardised incidence ratios (SIR) were calculated for each cohort and rates between cohorts were compared using Cox proportional HR, adjusted using inverse probability of treatment weighting.ResultsSIR for skin cancer was increased in both cohorts compared with the English population: SIR 1.72 (95% CI 1.43 to 2.04) anti-TNF; 1.83 (95% CI 1.30 to 2.50) nbDMARD only. In patients without previous skin cancer, BCC incidence per 100 000 patient-years was 342 (95% CI 290 to 402) after anti-TNF and 407 (95% CI 288 to 558) after nbDMARD. HR after anti-TNF adjusted for treatment weighting was 0.95 (95% CI 0.53 to 1.71). SCC incidence per 100 000 patient-years: anti-TNF 53 (95% CI 33 to 79); nbDMARD 43 (95% CI 12 to 110); adjusted HR 1.16 (95% CI 0.35 to 3.84).ConclusionsSkin cancers were increased among treated patients with RA. No evidence was found that anti-TNF therapy exacerbates the risk of BCC or SCC but this cannot be excluded. Patients with RA should use sun protection and be monitored for skin cancer.

Comparative Risk of Harm Associated With the Use of Targeted Immunomodulators: A Systematic Review

“…We also assessed comparative evidence for nontuberculosis opportunistic infections (48,49), skin infections (32), septic arthritis (50), nonmelanoma skin cancers (45,51,52), melanoma (45), congestive heart failure (53), and interstitial lung disease (54). For all of these outcomes, we identified extremely limited evidence from only observational studies.…”

Therapeutic potential of IL-15 in rheumatoid arthritis

“…However, skin cancers were increased among RA patients with anti-TNF therapy [76]. In addition, anti-TNF-α therapy may cause disseminated Mycobacterium haemophilum infection manifesting as skin lesions in RA patients [77].…”

The Reported Adverse Effects Related to Biological Agents Used for the Treatment of Rheumatic Diseases in Turkey

“…Mercer et al [47] in an evaluation of data from a British biologics registry revealed that the SIRs for skin cancer were increased for both anti-TNFs (1.72; 95% CI 1.43-2.04) and non-biological DMARDs (1.83; 95% CI 1.30-2.50). In addition, they discovered that the rate of skin cancer increased among patients with RA who were treated with either DMARDs or biologics.…”