RESEARCH - Incidence of melanoma and other malignancies among RA patients treated with MTX

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Arthritis Rheum. 2008 Jun 15;59(6):794-9.

Incidence of melanoma and other malignancies among rheumatoid

arthritis patients treated with methotrexate.

Buchbinder R, Barber M, Heuzenroeder L, Wluka AE, Giles G, Hall S,

Harkness A, D, Littlejohn G, MH, PF, Jolley D.

Cabrini Hospital and Monash University, Melbourne, , Australia.

OBJECTIVE: To determine cancer risk in a cohort of 459 rheumatoid

arthritis (RA) patients treated with methotrexate in community

practice.

METHODS: All RA patients who started methotrexate prior to June 1986

and were attending 1 of 6 rheumatologists were studied. Demographic

data were matched to the State Cancer Registry to identify all

malignancies (except nonmelanoma skin cancer) for 1983-1998, and to

the National Death Index to identify all deaths to the end of 1999.

Followup started on the date when methotrexate was started and ended

either on the last confirmed date on which the patient was seen by the

rheumatologist or at death. Standardized incidence ratios (SIRs) were

calculated using state population cancer rates stratified by sex, age

(in 5-year groups), and calendar year.

RESULTS: There were 4,145 person-years of followup (average 9.3

years). Eighty-seven malignancies were identified (14 before, 64

during, and 9 after the followup period). There was an estimated 50%

excess risk of malignancy among methotrexate-exposed RA patients

relative to the general population (SIR 1.5, 95% confidence interval

[95% CI] 1.2-1.9), with a 3-fold increase in melanoma (SIR 3.0, 95% CI

1.2-6.2), a 5-fold increase in non-Hodgkin's lymphoma (SIR 5.1, 95% CI

2.2-10.0), and an almost 3-fold increase in lung cancer (SIR 2.9, 95%

CI 1.6-4.8).

CONCLUSION: Compared with the general population, methotrexate-treated

RA patients have an increased incidence of melanoma, non-Hodgkin's

lymphoma, and lung cancer. There may be a role for regular skin cancer

screening for all RA patients, particularly those receiving

immunosuppressive therapy.

PMID: 18512713

http://www.ncbi.nlm.nih.gov/pubmed/18512713

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