Rheumatoid arthritis, TNF inhibitors, and non-melanoma skin cancer
Menée en Suède à partir de données portant sur 58 967 patients atteints d'une arthrite rhumatoïde et sur des témoins en population générale, cette étude de cohorte prospective évalue l'association entre un traitement avec des inhibiteurs du TNF et le risque de carcinome épidermoïde ou basocellulaire de la peau
Shervin Assassi, associate professorUniversity of Texas Health Science Center at Houston, 6431 Fannin, MSB 5.266, Houston, TX 77030, USAshervin.assassi{at}uth.tmc.eduMost of the excess risk is related to the disease, not the treatmentBasal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the two most common types of non-melanoma skin cancer. Epidemiological studies have indicated that the incidence of non-melanoma skin cancers is higher in patients with rheumatoid arthritis than in the general population.1 2 Further concerns exist that immunosuppression contributes to an increased prevalence of these malignancies. Specifically, organ transplantation and the concomitant use of immunosuppressive agents is strongly associated with SCC and to a lesser extent with BCC.3 4 Tumor necrosis factor (TNF) inhibitors are the most commonly used biological immunosuppressive agents for treatment of rheumatoid arthritis. Pooled data from 74 randomized controlled trials showed that TNF inhibitors were associated with an increase in risk of non-melanoma skin cancer beyond the risk associated with rheumatoid arthritis alone.5 Several large observational studies have supported this finding,6 7 but others have not.8 9 …