The risk of malignancy in patients with rheumatoid arthritis (RA) is not significantly associated with the use of biologic response modifiers (BRMs) compared with other disease-modifying antirheumatic drugs (DMARDs) or with placebo, according to a meta-analysis of randomized controlled trials (RCTs) reported in the Journal of the American Medical Association. Investigators searched electronic databases, conference proceedings, and Web sites of regulatory agencies for RCTs that evaluated abatacept, adalimumab(Drug information on adalimumab), anakinra(Drug information on anakinra), certolizumab, etanercept(Drug information on etanercept), golimumab, infliximab(Drug information on infliximab), rituximab(Drug information on rituximab), and tocilizumab in RA from inception through July 9, 2012. Independent reviewers selected studies and extracted data on quality and outcomes; 63 RCTs were analyzed.
No statistically significant increased risk of malignancy was observed. During the trials, a malignancy developed in 211 of 29,423 patients (118 solid tumors, 48 skin cancers, 14 lymphomas, 5 hematologic nonlymphomas, and 26 not specified). The incidence rate for any malignancy during the first year of therapy was very low in the BRM plus methotrexate(Drug information on methotrexate) group, the BRM monotherapy group, and the controls. No statistically significant risk was observed for specific cancer sites.