Dr. W. Hayes Wilson, a rheumatologist in Atlanta who is a national medical adviser for the Arthritis Foundation, added that the risks of cyclophosphamide have been recognized for years, although he personally could not recall any of his patients developing the blood cancer.
According to Wilson, cyclophosphamide is no one's first choice for treatment and is only used in the more severe cases. "You're sort of choosing between two evils," Wilson said. "No one wants to jump out of a perfectly good airplane, but if that airplane had two engines, and one was on fire, I might strap on that parachute and jump."
The study did not present data on any risks associated with new biologic medications, such as Embrel, Humira, and Remicade, which have been available since about 2000, Lindsey and Wilson said. There have been other studies with positive results for one category of these drugs, called TNF-alpha inhibitors, Wilson said. For severe cases, "when we treat them aggressively with a biologic modifier, perhaps we are bringing their risk down to similar to the general population," he said.
There's more on rheumatoid arthritis at the Arthritis Foundation.
SOURCES: Sasha Bernatsky, M.D., division of clinical epidemiology, McGill University Health Centre, Montreal; Stephen Lindsey, M.D., chief, rheumatology, Ochsner Clinic Foundation, Baton Rouge, La.; W. Hayes Wilson, M.D., National Medical Adviser, Arthritis Foundation, and chief, rheumatology, Piedmont Hospital, Atlanta; Feb. 25, 2008, Archives of Internal Medicine
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