Editorials

Rheumatoid arthritis, TNF inhibitors, and non-melanoma skin cancer

BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i472 (Published 28 January 2016) Cite this as: BMJ 2016;352:i472
  1. Shervin Assassi, associate professor
  1. University of Texas Health Science Center at Houston, 6431 Fannin, MSB 5.266, Houston, TX 77030, USA
  1. shervin.assassi{at}uth.tmc.edu

Most of the excess risk is related to the disease, not the treatment

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the two most common types of non-melanoma skin cancer. Epidemiological studies have indicated that the incidence of non-melanoma skin cancers is higher in patients with rheumatoid arthritis than in the general population.1 2 Further concerns exist that immunosuppression contributes to an increased prevalence of these malignancies. Specifically, organ transplantation and the concomitant use of immunosuppressive agents is strongly associated with SCC and to a lesser extent with BCC.3 4 Tumor necrosis factor (TNF) inhibitors are the most commonly used biological immunosuppressive agents for treatment of rheumatoid arthritis. Pooled data from 74 randomized controlled trials showed that TNF inhibitors were associated with an increase in risk of non-melanoma skin cancer beyond the risk associated with rheumatoid arthritis alone.5 Several large observational studies have supported this finding,6 7 but others have not.8 9 …

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