REVIEW - Better cancer screening needed before TNF blockade

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Better Cancer Screening Needed Before TNF Blockade

NEW YORK (Reuters Health) Jul 07 - In randomized controlled trials

involving anti-TNF-alpha treatment of rheumatoid arthritis, psoriatic

arthritis, and ankylosing spondylitis, occult cancers are frequently

missed before treatment begins, Italian researchers report in the June

15th issue of Arthritis & Rheumatism

Dr. Carlotta Nannini of Hospital Misericordia e Dolce in Prato and

colleagues reviewed 36 trials involving more than 12,000 patients.

Malignancies developed in 60 (0.75%) patients randomized to active

treatment and 21 (0.52%) randomized to placebo groups.

While the authors note that malignancies are a possible adverse effect

of TNF-alpha blockade, Dr. Nannini commented to Reuters Health that

" twenty-six percent of malignancies were, in fact, diagnosed within 12

weeks from the therapy initiation, both in the treatment group and the

placebo group. "

" The review, " Dr. Nannini said, " reveals the inadequacy of the

screening procedures currently adopted in randomized controlled

trials. "

To examine their own performance in screening, Dr. Nannini and her

co-authors reviewed data on 363 patients with rheumatoid arthritis,

psoriatic arthritis, or ankylosing spondylitis who had received

anti-TNF-alpha therapy at a secondary referral center after intensive

cancer screening. They were compared with 73 historic controls treated

with the same medications for the same conditions who were less

thoroughly screened.

At a mean follow-up of roughly 40 months, 1 study patient (0.27%) and

3 controls (4.1%) developed cancer.

" Anti-TNF alpha treatment requires...an adequate laboratory and

radiologic evaluation to detect occult cancer, " Dr. Nannini said. " The

increased risk of neoplasia among patients with rheumatic diseases

treated with anti-TNF-alpha should be critically interpreted and more

accurate screening procedures should be considered before therapy

initiation. "

Arthritis Rheum 2009;61:801-812.

http://www.medscape.com/viewarticle/705489

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