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RA Drugs Not Implicated In Cancer

Rheumatoid arthritis (RA) patients have an increased risk of developing lymphoma and leukemia. The autoimmune, inflammatory disease that causes a lot of joint pain does have the risk of cancer. //Researchers speculate that antirheumatic drugs (DMARDs) – including tumor necrosis factor alpha (TNFá) antagonists, a type of biologic DMARD may play a role in this.

TNF blockers, which work by attaching to and impeding chemical messengers behind inflammation, have had a significant impact on the treatment of RA. They have also been linked to lymphoma among users. In fact, reports of lymphoma prompted the Food and Drug Administration to mandate adding a cancer risk warning to the labels of three TNF blockers: etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira).

Motivated by persistent concerns and inconclusive studies, researchers at Harvard Medical School's Brigham and Women's Hospital set out to investigate the association between treatment with TNF blockers and occurrence of cancer in a large sample of patients with RA. Their results, featured in the September 2006 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/
journal/arthritis), indicate that biologic DMARD therapy poses no greater risk for cancer than therapy with a standard prescription DMARD, methotrexate (MTX).

The researchers focused on 7,830 RA patients, age 65 and older, drawn from healthcare databases in New Jersey, Pennsylvania, and British Columbia, Canada. Subjects included 1,152 biologic DMARD users and 7,306 MTX users. Of those treated with a biologic DMARD, 64 percent had used etanercept, 33 percent had used infliximab, and the remaining 2 percent had used anakinra (Kineret). 55 percent had previously used MTX and 39 percent were receiving MTX when they began anti-TFN therapy.

Based on medical utilization information, the researchers measured every subject's general health and RA-related characteristics during the 6-mo
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