Kickas.org Forums Treatments, Drugs and Alternatives Anti TNF and other biological medications Arthritis Drugs Not Tied to Increased Cancer Risk

Rheumatoid arthritis patients who take the biologic drugs Remicade, Humira, and Enbrel do not appear to have an increased risk for developing cancer in the first few years of use, researchers in Sweden report.

The study is one of the largest and longest population-based investigations ever into the cancercausing potential of the drugs, known as tumor necrosis factor (TNF) inhibitors.

TNF inhibitors were introduced a decade ago, and they represent a significant advance in the treatment of patients with rheumatoid arthritis, Crohn's disease, and other diseases of the immune system who do not respond to traditional treatments.

Concerns that the drugs may cause cancer emerged soon after they were introduced, and the research examining the question has been mixed.

The new findings should reassure patients, but questions remain about the short-term and long-term safety of TNF-blocking drugs, rheumatologist Eric Matteson, MD, of Mayo Clinic in Rochester, Minn., tells WebMD.

More info can be found in the article
http://www.medicinenet.com/script/main/art.asp?articlekey=107135

Here in France it is reported that side effects can be that of cancer - so says two rhuematologists. But, one, the Prof says, "c'est n'est pas grave!" The other has lost patients of his to cancer, cancer of the liver. He, found the postition 'grave'.

See that the Swedish report admits to conflicting opinions:-
"Concerns that the drugs may cause cancer emerged soon after they were introduced, and the research examining the question has been mixed."

Hi Molly,

I doubt they are saying that in France but regardless, the Swedish study being referred to was long term, robust and captured a very large sample size of RA patients - 6,366!

Does the risk change with the time since start of treatment? (link - www3.interscience.wiley.com)
Under results: "RRs (relative risks) did not increase with increasing time since the start of anti-TNF therapy, nor with the cumulative duration of active anti-TNF therapy."

And conclusion: "During the first 6 years after the start of anti-TNF therapy in routine care, no overall elevation of cancer risk and no increase with followup time were observed."
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These medications have not only proven to be incredibly efficacious as therapy for inflammatory arthritis but safe as well. In fact, the safety profile looks far better than nsaids, imho. It worries me that people will be unnecessarily frightened off trying something that could very well protect their health, when the facts are not offered in a balanced manner.

It is important for folks to be aware that uncontrolled inflammation *itself* increases a patients relative risk of developing cancer. People suffering with moderate to severe AS and RA, risk poor health outcomes and very real dangers (that are not rare) when they choose to forego effective treatment options, due only to fear rather than fact.

The opinion of one or two rheumatologists in any country is not worth a hill of beans in comparison to these large scale studies. Not in my opinion.

Just my take on it!
mig

It would be interesting to see a meta-study reviewing previous studies of substances that have been found to increase cancer risk, to find out what length of time it takes to see a plausible link. Is 6 years typically long enough to see much effect? I speculate it depends on the type of cancer; some grow much faster than others.

(this was meant in reply to the original article btw, not in response to Mig's discussion on inflammation itself as cancer risk which is something I've also heard)

Quote: "I doubt they are saying that in France."

Was said to the whole conference, about 200 attendees in response to my question. IF the whole transcript is given, then I will send you a copy of the transcript Mig. In France my own Prof, one of only two Profs in Brittany, claimed that the cancers caused by the anti-TNF drugs were, not serious, not grave, and that 'they in France soon dealt with them - they cut them out!' In addition, the consultant rheumatologist at a hospital here in Brittany told me himself that a number of his own patients were suffering from the side effects of the anti'TNF drugs to the extent of dying from said side effects, namely, lymphomas.

No, I am not mistaken and am quite prepared to supply you with their names and the names of the hospitals. Both the Prof and the doctor speak superb English.

It cannot be denied that there are side affects to the NSAIDs, to the DEMARDS and to the anti'TNFs. To claim otherwise is to do a total diservice to ALL patients.

Sure, the anti'TNFs 'might' suit some patients, they suit you Mig, the same as you are able to 'stomach' the NSAIDs - which I cannot tolerate, including even this new one. Hopeless. Wretched LPRG. Indeed, there are many who are unable to stomach them (including my fellow student, whom, yes, I was able to speak to about KA this evening. He is most interested in joining - I will be seeing him again on Wednesday at French class, when I will give him this web address).

The anti'TNFs might lead to cancer in just a few cases, but still 'can', 'may' lead to cancer. And if you read the full report as Manju posted, the jury is seemingly out - not in total agreement. Will be interesting to 'see' what transpires in the long term.

Drugs and their side effects are increasingly being brought into the light. ALL patients 'need' to know 'what' side effects might be involved with each and *every drug. The side effects of any drug should not be hidden.

Once could but wish that there were no side effects - that all was wondrous light and cures. Such though is not the case.

Peace -

Quote: "It is important for folks to be aware that uncontrolled inflammation *itself* increases a patients relative risk of developing cancer. People suffering with moderate to severe AS and RA, risk poor health outcomes and very real dangers (that are not rare) when they choose to forego effective treatment options, due only to fear rather than fact."

Mig, one is speaking of patients who ARE on these drugs, who have been on the drugs for a time. There is nowt else in France anyways! You either 'do' and 'take' or you are not treated! That is the whole point over here. Thre are no 'other treatment options'. Heck, even the pharmacies (chemists) do not stock much by way of alternatives. CODEX has stopped it...

I bring my own alternatives over from the UK or chums pick em up for me - same with all the Brits over here. Alternatives are pretty much non-existent.

Again, just speaking with my felow student this evening. He has had a hell of two days. His guts are ripped apart with the NSAIDs and he is unable to take the biggie drugs - and, NO alternatives available to him!

Pretty dire when there are NO alterntives available - and there aren't, not in France. Sigh. One but wished that these biggie drugs DID work, and worked for everyone. But, they don't and with no alternatives available then...difficult.

One sooooo wishes that it were not so. 'Smile'.

For a matter of idle interest I googled in: anti-TNF drugs link to cancer - have not checked out all the links, there were just too many:-

Web ResultsComplications of Anti-TNF Therapies: Do Anti-TNF Drugs ...

Do Anti-TNF Drugs Increase the Risk of Malignancies? Overall Cancer Rates. TNF-α plays an important role in surveillance of malignancy and hence there is a ...
www.medscape.com/viewarticle/568635_8 - Similar

Anti-TNF Medications Linked to Nonmelanoma Skin Cancer
Oct 21, 2009 ... There is a modest increase in the risk for basal cell and squamous cell carcinoma in rheumatoid arthritis patients who take anti-tumor ...
www.medscape.com/viewarticle/711093 - Similar

[ More results from www.medscape.com ]
arc :: Arthritis drugs and cancer - is there a link?
Anti-TNF therapy and cancer. Anti-TNF therapy is directed against a chemical in ... with anti-TNF are registered – is to establish whether these drugs are ...
www.arc.org.uk/news/arthritistoday/136_2.asp - Similar

Psoriatic Arthritis - Cancer, psoriatic arthritis, and ...
Oct 22, 2009 ... Cancer, psoriatic arthritis, and anti-TNF drugs (Enbrel, Humira, Remicade, ... one or more of the anti-TNF drugs (humira, enbrel, remicade). ...
www.hopkins-arthritis.org/ask-the-expert/psoriatic-ar... - Similar

Biologic DMARDs - Dosage - Side Effects - Interactions - Warnings
Biologics (BRMs, TNF Blockers, Biologic DMARDs) drug information, dosage, ... TNF blockers and other biologic DMARDs (disease-modifying anti-rheumatic drugs), ... 03/01/2006, Rituxan, the world's best-selling cancer drug, has been FDA ...
arthritis.about.com/od/brms/Biologic_DMARDs_Dosage_Si... - Similar

Medical News: No Increased Cancer Risk with Anti-TNF Therapy ...
For example, some patients treated with the anti-TNF drugs may have been at higher risk of cancer because of treatment with other immunosuppressive agents ... (looks like a grand case of wriggling pharma...'smile')i]
www.medpagetoday.com/Rheumatology/Arthritis/16684 - Similar

Skin cancer in psoriatic arthritis treated with anti-TNF ...
As anti-TNF {alpha} drugs are more widely used in patients with psoriasis the potential for an increased risk of skin cancer should be recognized. ... [i](maybe that is why the Prof said to 'cut it out'...!)
rheumatology.oxfordjournals.org/cgi/content/full/kem214v1 - Similar

Amazon.com: Anti-TNF drugs tied to skin cancer.(RHEUMATOLOGY ...This digital document is an article from Internal Medicine News, published by International Medical News Group on November 15, 2009. ...
www.amazon.com/Anti-TNF-cancer-RHEUMATOLOGY-necrosis-... - Similar

Anti-TNF Drugs Tied to Skin Cancer
Anti-TNF Drugs Tied to Skin Cancer. DENISE NAPOLI Internal Medicine News 42:2020 , 43-43, Elsevier Inc., 11/2009.
linkinghub.elsevier.com/retrieve/pii/S1097869009708339 - Similar

Link Found Between anti-TNF Medication and Cancer - Wellsphere
[b]Jul 17, 2008 [/b]... Anti-tumor necrosis factor (TNF) drugs are the newest class of therapies used for ... After stopping the anti-TNF treatments “the cancer has ...
stanford.wellsphere.com/arthritis-article/link-found-... - Similar

(this last was quite interesting. Patient developed lung cancer, she was a smoker. Drugs stopped. Cancer went. How odd.)

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Whatever the findings are, on whatever the drug being used, prescribed, discussed, it is the patient's and the person's right to 'fully know', to be 'fully advised of' ALL side effects. It is malpractice to treat otherwise. IMO.

This ALSO stands for ALL supplements, herbals, vitamins, and alternative therapies, whether to be imbibed, injected, or treated with - i.e. chiropractice, physiotherapy, hypnotherapy, acupuncture etc etc. This ALSO is to be observed for regimes, i.e. diets, whatever their nature. ALL side effects or potential side effects should be made known, and NO single side effect nor potential side effect should be hidden.

That is the only correct way to proceed. But that is my own opinion - and my own opinion is but mine own...'smile'.

It's true that there are side effects and risks to everything, Molly. Some are mild, some more serious, some rare and all the evidence is not in yet. Some 'associations' that are written about as 'possibly' linked are not 'causally' linked and fully understanding all the medical language is far from easy, for many of us.

Yes, there are risks. There's probably an increased cancer risk associated to eating a hunk of nicely aged cheddar cheese too but I am still going to eat it! (yum) And yes, there are risks also to nsaids, dmards, acupuncture, chiropractic, physiotherapy, supplements, herbal remedies,... and to doing nothing!

For perspective and balance, a French study:
From PubMed: Epub 2009 Oct 14:
Hôpital de Bicêtre, Le Kremlin Bicêtre, France.
Results of the 3-year prospective French RATIO registry.
"OBJECTIVE: To describe cases of lymphoma associated with anti-TNF therapy, identify risk factors, estimate the incidence and compare the risks for different anti-TNF agents."
"CONCLUSION: The two to threefold increased risk of lymphoma in patients receiving anti-TNF therapy is similar to that expected for such patients with severe inflammatory diseases. Some lymphomas associated with immunosuppression may occur, and the risk of lymphoma is higher with monoclonal-antibody therapy than with soluble-receptor therapy."

And from one of your links, from Medscape Rheumatology:
http://www.medscape.com/viewarticle/711093
The article on anti-TNF meds linked to Nonmelanoma Skin Cancer
"Although the trend was for increased risk with anti-TNF therapy, the absolute risk was low."
"The strongest predictor of nonmelanoma skin cancer was previous nonmelanoma skin cancer."
(bold emphasis is mine)

I have never claimed nor denied there are risks associated with anti-tnf therapy - but I do strongly believe that the real 'disservice' is when they are presented in an exaggerated and/or unbalanced manner.

Like many of us with AS, I don't have the luxury of mild disease and encourage only that risk vs benefits for treatment be weighed on a personal basis, in relation to one's own personal disease status and prognosis and after discussion with one's doctor. These meds are not and should not be for everyone, but in cases of severe illness - they are a godsend, (in my opinion. ~smile)

Take care,
mig

Hi Mig - that's why I picked a raft of info, so that there 'would' be a fairly balanced view/input.

Don't think I would refer to this disease as a 'luxury', mild or otherwise, <VBG> but know what you mean... It's an EEEK disease, and ALL the possible attendant diseases make it even more EEKY.

Good you found that French study - bears out what the Prof was declaiming on and my GP substantiated (this morning): "IF you get such a side effect, 'cut it out!'" Ho-Hum.

Thanks for input Mig -

Take care -

I guess what I want to throw into this discussion is that methotrexate may destroy my liver and I'm forced to test my blood every month in order to monitor my liver function. But what are my alternatives? So far, there are no diets clearly identified to eliminate RA. I have worked my way through the lesser DMARDS. I'm very reluctant to stay on NSAIDS - we all know the potential risks of them. Prednisone works but we also know the long term risks of that - check in with Possi. Narcotics take the edge off the pain but do little more and don't leave me functioning very well - nor do they slow down potential damage.

So what does that leave me? If mtx doesn't work, then I'm on to bigger drugs, maybe even to TNFs if nothing else works. My alternative is to end up like my grandmother - horrifically damaged and disabled. Her hands were twisted, broken and almost useless. Her big toes lay sideways across her other toes and I have no idea how she tried to walk. Her hips were destroyed. None of the DMARDs were available to her, let alone the TNFs - she had to rely on aspirin. She died of bowel cancer in her 70s. I'm quite sure she would have been willing to take the small risk of cancer from a TNF to have had a better quality of life for decades prior to her death.