Abstract
Anti-tumor necrosis factor alpha (TNF-α) agents have become an established treatment option for rheumatoid arthritis (RA), but are not without risks. As TNF-α has a role in tumour surveillance, anti-TNF-α blockade could potentially increase the risk of malignancy. Recent meta-analysis by Bongartz et al. (JAMA 295:2275–2285, 2006) reported an increase in the incidence of malignancy attributed to anti-TNF-α antibodies, and the information has quickly and uncritically reached several secondary sources with huge effects on public perception of risks related to anti-TNF-α therapy. In contrast, the results from the British Society for Rheumatology Biologics Register show that in clinical practice, anti-TNF-α therapy in RA does not appear to increase the risk of malignancy in those patients with low risk of malignancy. We discuss the issues emerging from these published data and suggest caution against giving weight to meta-analysis of short-term drug studies.
This is a preview of subscription content, log in via an institution to check access.
References
Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Mattison EL, Montori V (2006) Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies. JAMA 295:2275–85 (correction JAMA 295:E1)
Listing J, Strangfeld A, Kary S et al (2005) Infections in patients with RA treated with biologic agents. Arthritis Rheum 52:3403–3412
Askling J, Fored CM, Brandt L et al (2005) Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists. Ann Rheum Dis 64:1421–1426
Wegener’s Granulomatosis Etanercept Trial (WGET) Research Group (2005) Etanercept plus standard therapy for Wegener’s granulomatosis. N Engl J Med 352:351–361
Fleischmann R, Baumgartner SW, Weisman MH, Liu T, White B, Peloso P (2006) Long term safety of etanercept in elderly subjects with rheumatic diseases. Ann Rheum Dis 65:379–384
Watson KD, Dixon WG, Hyrich KL, Lunt M, Symmons DPM, Silman AJ (2006) Influence of anti-TNF therapy and previous malignancy of cancer incidence in patients with rheumatoid arthritis: results from the BSR biologics register. Rheumatology (Oxford) 45(Suppl 1):i10
Symmons DP, Silman AJ (2006) The world of biologics. Lupus 15:122–126
Tonks A (2006) Meta-analysis finds rare but serious side effects. BMJ 332:1264
In Brief (2006) Drugs for arthritis triple cancer risk. Nurs Times 102(21):8
Reuters Health Information (2006) Anti–TNF antibody therapy for RA increases cancer and infection risk. Available at http://www.medscape.com/viewarticle/532660 Accessed on 29 May 2006
Groch J (2006) Rare risks tied to anti-TNF agents for RA. Medpage Today. Available at http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/tb/3308 Accessed on 29 May 2006
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dziadzio, M., Smith, R. Meta-analysis is no substitute for a comprehensive national registry. Clin Rheumatol 26, 1134–1135 (2007). https://doi.org/10.1007/s10067-006-0445-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-006-0445-5