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Research on Meds

Anti-TNF Medications
Remicade® and Humira® Increase Risk of Cancer

According to an article recently published in the Journal of the American Medical Association, patients taking the rheumatoid arthritis drugs Remicade® (infliximab) or Humira® (adalimumab) had a three-fold increased risk of developing various types of cancers.

Remicade and Humira are agents referred to as anti-tumor necrosis factor (Anti-TNF) antibodies; they have demonstrated effectiveness in the treatment of severe rheumatoid arthritis. An issue surrounding these agents is that tumor necrosis factor is thought to provide protection against cancer and infection. The use of anti-TNFs that block the productivity of tumor necrosis factor has thus been associated with an increased risk of infection and possibly various types of cancers.

Researchers from the Mayo Clinical conducted a study to further evaluate the potential effects of Remicade and Humira on the incidence of cancer. The study included data from nine clinical trials that compared anti-TNF therapy to placebo (inactive substitute) in patients with rheumatoid arthritis. The studies included over 3,000 persons receiving anti-TNF therapy and over 1,500 receiving placebo (control group).


  • Patients taking anti-TNF therapy had over a three-fold increased risk in developing a cancer than the control group.
  • Patients treated with high doses of anti-TNF therapy had a 4.3-fold increased risk of developing cancer compared to the control group.
  • Patients treated with low doses of anti-TNF therapy had a 1.4-fold increased risk of developing cancer compared to the control group.
  • Types of cancers that were increased were lymphomas, skin cancer, breast cancer, lung cancer, and gastrointestinal tract cancers.
  • This data represents one additional cancer for every 154 patients treated with anti-TNF therapy.
The researchers concluded that treatment with anti-TNF therapy increases the risk of developing cancers, particularly among patients treated with high doses of this type of therapy. Patients undergoing treatment with anti-TNF therapy should speak with their physician regarding their individual risks and benefits of treatment.

Reference: Bongartz T, Sutton AJ, Sweeting MJ, et al. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serous infections and malignancies. Journal of the American Medical Association. 2006;295:2275-2285.

Rheumatology, Published: Mar 27, 2013
Adverse Events with Humira Stay Low Over Time

http://www.medpagetoday.com/Rheumatology/Arthritis/38106

The researchers disclosed financial relationships with various companies, including Abbott, Essex/Schering-Plough, Novartis, Roche, Bristol-Myers Squibb, Centocor, Elan, and Amgen. Two are employees of Abbott.
Anti-Interleukin 6 medications
Treatment Information for Rheumatologists: Actemra

 http://www.actemrahcp.com/

Tocilizumab for the Treatment of Rheumatoid Arthritis and Other Systemic Autoimmune Diseases: Current Perspectives and Future Directions

http://www.hindawi.com/journals/ijr/2012/946048/

Long Term Safety and Efficacy of Tocilizumab, an anti-IL-6 receptor monoclonal anti-body, in monotherapy, in patients with rheumatoid arthritis, (the STREAM study): evidence of safety and efficacy in 5-year extension study.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732899/

Arthritis Rheum. 2006 Sep;54(9):2817-29.

Double-blind randomized controlled clinical trial of the interleukin-6 receptor antagonist, tocilizumab, in European patients with rheumatoid arthritis who had an incomplete response to methotrexate.

http://www.ncbi.nlm.nih.gov/pubmed/16947782/

Alimentary Pharmacology & Therapeutics Volume 28, Issue 2, pages 228–238, July 2008

Comparative effectiveness of azathioprine in Crohn’s disease and ulcerative colitis: prospective, long-term, follow-up study of 394 patients
  1. J. P. GISBERT, P. NIÑO, C. CARA and L. RODRIGO
Article first published online: 28 JUN 2008

Summary

Background
The long-term efficiacy for thiopurinic drugs in Crohn’s disease (CD), and particularly in ulcerative colitis (UC), has been insufficiently studied.


Aim To evaluate prospectively and compare the long-term effectiveness of azathioprine (AZA) in CD and UC.

Methods Three hundred and ninety-four AZA treated patients were included consecutively included. Truelove-modified index and CDAI were used to assess effectiveness. Hospitalizations and surgical procedures were recorded.

Results Two hundred and thirty-eight patients with CD and 156 with UC received AZA for a median of 38 months. Effectiveness: Partial response/remission was achieved in 34%/49% of CD patients and in 47%/42% of UC (nonstatistically significant differences). Steroid treatment: Prior to AZA, 49% of CD patients were receiving steroids, whereas only 8% needed steroids after therapy (P < 0.001). Corresponding figures in UC patients were 39% vs. 9% (P < 0.001). Hospitalizations: Prior to AZA, the rate of hospitalizations in CD was 0.190 per-patient-year, while after treatment, it decreased to 0.099 (P < 0.001). Corresponding hospitalization rates in UC were 0.108 vs. 0.038 (P < 0.001). Surgery: The rate of surgery in CD prior/after AZA was 0.038/0.011 per-patient-year (P < 0.001). The number of surgical interventions in UC prior/after AZA treatment was 26/0 (the rate per-patient-year was 0.018/0) (P < 0.001).

Conclusions Our results confirm the effectiveness of AZA in inflammatory bowel disease, not only in the short term but also in the long term, resulting in a steroid sparing effect and in both a reduction in the number of hospitalizations and surgical procedures. AZA is similarly effective for both CD and UC patients

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2008.03732.x/abstract















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