Tumor necrosis factor-alpha inhibitors: Risk of malignancy
- Kimme Hyrich, MD, PhD, FRCPC
Kimme Hyrich, MD, PhD, FRCPC
- Professor of Epidemiology and Honorary Consultant in Rheumatology
- Centre for Musculoskeletal Research
- Institute of Inflammation and Repair
- The University of Manchester
- Section Editor
- Daniel E Furst, MD
Daniel E Furst, MD
- Section Editor — Treatment Issues in Rheumatology
- Clinical professor, University of Washington, Seattle
- Clinical professor, University of Florence, Florence, Italy
- Professor of Rheumatology, University of California in Los Angeles (Emeritus)
- Director of Research, Pacific Arthritis Associates
Inhibitors of tumor necrosis factor (TNF)-alpha represent important treatment advances for a number of inflammatory conditions, including rheumatoid arthritis (RA), the seronegative spondyloarthropathies, inflammatory bowel disease (IBD), and psoriasis. TNF-alpha inhibitors offer a targeted strategy that contrasts with the nonspecific immunosuppressive agents traditionally used to treat most inflammatory diseases.
However, multiple potential adverse effects of TNF-alpha inhibition have been reported through both clinical trials and postmarketing surveillance. These include:
●Injection site reactions
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- GENERAL ISSUES
- Inhibitors of TNF-alpha
- TNF-alpha biology
- Measures of risk
- - Standardized incidence ratios
- - Relative risk
- CHALLENGES IN ESTABLISHING MALIGNANCY RISK
- STUDIES OF OVERALL CANCER RISK
- Evidence of increased risk
- Evidence of no increased long-term risk
- LYMPHOMA RISK
- Studies suggesting increased lymphoma risk
- Studies suggesting no increased lymphoma risk
- SOLID MALIGNANCY RISK
- Cyclophosphamide and TNF inhibitor combination
- - Etanercept label warning
- SKIN CANCER RISK
- Non-melanoma skin cancer
- Malignant melanoma
- CANCER RISK IN PATIENTS WITH PRIOR MALIGNANCY
- SUMMARY AND RECOMMENDATIONS