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Relative risk for invasive melanoma greater among RA patients treated with anti-TNFs
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Patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors had a 50% increased relative risk for invasive melanoma but not a significantly increased overall burden of cancer, according to recent study results.
Julia F. Simard, ScD, assistant professor at Karolinska Institutet in Stockholm, Sweden, and colleagues conducted a nationwide population-based cohort study of participants diagnosed with rheumatoid arthritis (RA) between 2001 and 2010 with no history of invasive cancer before study inclusion. The cohort included 42,198 patients (median age, 62 years; 72% women) not treated with tumor necrosis factor (TNF) inhibitors and 10,878 patients (median age, 57 years; 76% women) who began TNF inhibitor therapy between 1998 and 2010. Patients were compared with a matched cohort from the general population (n=162,743; median age, 62; 71% women).
Julia F. Simard
First invasive melanoma was the primary outcome. Cox regression models estimated hazard ratios to compare the nonbiologically treated RA patients with the general population cohort and also with the TNF inhibitor-treated RA patients. In situ melanomas, secondary primary melanomas and all-site cancer were secondary outcomes.
Biologic-naive RA patients experienced 113 first invasive melanomas compared with 393 in the general population cohort and were not at significantly increased risk for melanoma by comparison (HR=1.2; 95% CI, 0.9-1.5).
Thirty-eight first invasive melanomas occurred in RA patients treated with TNF inhibitors, and these patients experienced an increased melanoma risk compared with RA patients not treated with the drugs (HR=1.5; 95% CI, 1.0-2.2; 20 additional cases per 100,000 person-years).
When compared with RA patients not being treated with biologics, the risk for secondary primary melanoma was not significantly increased in the RA patients treated with TNF inhibitors (HR=3.2; 95%, 0.8-13.1).
“Given the small increase in absolute risk, these findings may not markedly shift the overall risk-benefit balance of TNF inhibitors as used in clinical practice but might do so in patients at high risk of melanoma for other reasons,” the researchers concluded.
Disclosure: Johan Askling, MD, PhD, reports receiving research grants from Pfizer and AstraZeneca as part of a public-private research consortium and speakers’ honorariums from Merck.
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