Arthritis Drugs May Increase Skin Cancer Risks

A study has confirmed that rheumatoid arthritis patients on Remicade or Enbrel have a small but higher risk of skin cancer. The study was conducted with 13,001 rheumatoid arthritis patients who twice a year completed detailed health questionnaires. The study, appearing in the September (08) issue of the journal Arthritis & Rheumatism, contradicts earlier findings that the new drugs raise patients' risk of solid tumors. But it supports earlier findings linking the new "TNF blocker" drugs to skin cancers, including potentially deadly melanomas.

Rheumatoid arthritis is an immune disease. So-called "TNF blocker" drugs interfere with an immune-system signal called tumor necrosis factor alpha, or TNF-alpha. That can be a huge benefit to people crippled by rheumatoid arthritis. But it can also expose patients to risks of serious infections and cancers. Three of these drugs are approved in the U.S.: Remicade, Enbrel, and Humira. The study, conducted from 1998 through 2005, included very few patients on Humira. Most of the study patients taking TNF blockers in this study used Remicade.

Lead researcher Frederick Wolfe, the director of the National Data Bank for Rheumatic Diseases, said that even with the increased cancer risk, there is no need for patients who need the medication to stop taking it.

A 2006 analysis of TNF-blocker clinical trials focused on Remicade and Humira (an update including Enbrel data is in the works). One of that study's investigators, Mayo Clinic rheumatologist Tim Bongartz, MD (not a participant in the Wolfe study) says Wolfe's findings are similar to those of Swedish investigators who also found a link between skin cancer and TNF blockers. "Three major clinical trials, in their malignancy data, all have some indication there is a problem with skin cancer with these drugs," Bongartz tells WebMD. "This has huge implications in how we examine these patients and how we advise these patients." Bongartz suggests doctors should do regular, thorough, whole-body skin examinations for every patient taking TNF blockers.

Wolfe is less concerned. "If there is a real message in these studies, it is that the overall risk of cancer is small in rheumatoid arthritis patients," he says. "The overall effect is to say things are much the same as they have been over the last several decades. I don't think people should be concerned. It may be these drugs turn out to be safe. It looks as though they are, and I am not particularly worried."

Bongartz says the real cancer risk of TNF blockers remains an open question. Apart from the question of cancer, Bongartz is certain that these drugs do increase a person's risk of a serious infection. But even this, he says, is no reason for patients who need the drugs to stop taking them. "It just tells doctors something about how to manage these patients," Bongartz says. "If someone turns up in the emergency room with vague symptoms, if that patient is taking a TNF blocker, the doctors should be more alert."

info from WebMD Medical News (8/07) New Arthritis Drugs: Skin Cancer Risk Study: Slightly Higher Skin Cancer Risk With Remicade and Enbrel By Daniel J. DeNoon Reviewed by Louise Chang, MD

Bone Health Compromised By Arthritis Drugs

As reported by HSI (The Health Sciences Institute) E-Alert UK Edition (Little Black List of Drugs That Put Your Bones in Considerable Danger) by Jenny Thompson 12/10 - What most women don't know about drugs and bone health could fill a book (or at least an e-Alert). No thanks to the American Food and Drug Administration (FDA)! The agency has sure not made it any easier for women to sort out fact from fiction when it comes to bisphosphonates (the class of osteoporosis drugs that includes Fosamax, Boniva, Reclast, and Actonel).

FDA officials announced that their review of bisphosphonate studies produced no evidence that the drugs increase risk of fractures to the thigh bone (femur) below the hip joint. But then, in October 2010, the agency issued a long- overdue warning about the risks of those very fractures in patients treated with bisphosphonates. You can just imagine the women out there who are shaking their heads in wonder, thinking, "But I was told this drug would PROTECT me from fracture."

Sure, it's a stupefying irony that so many osteoporosis drugs may increase fracture risk. But there are actually three other classes of very popular drugs that put women's bones in considerable danger.

Proton Pump Inhibitors (PPIs)

Three years ago I mentioned a study that linked the use of PPI heartburn drugs to an increased risk of hip fracture. In subjects who used a PPI over a long period, fracture risk increased significantly. The following year, another study reported: "Use of proton pump inhibitors for 7 or more years is associated with a significantly increased risk of an osteoporosis-related fracture."

Asthma Inhalers

Doctors have known for some time that taking steroids in pill form contributes to bone loss. In a 2001 study of 109 women between the ages of 18 and 45, researchers found that subjects who took frequent puffs from asthma inhalers significantly increased their rate of bone loss. Researchers recommended that asthma patients use the lowest effective dose from inhalers, engage in weight-bearing exercise, and supplement with calcium and vitamin D.


In a five-year trial that followed 8,000 women over the age of 65, subjects who took antidepressant drugs were found to be 70 per cent more likely to suffer disabling hip fractures. Researchers suspect that reduced alertness, prompted by the drug use, may have played a role in the higher incidence of fractures.


I have one last note on bisphosphonates from an HSI member named Alice who also happens to be a doctor. "Be sure to tell everybody that oral surgeons won't touch people on bisphosphonates either because their ability to heal extraction sites or oral injuries is less and they also might risk a lower success rate with implants. "Since a lot of us over 55 have dental problems this is a BIG issue especially for women who are targeted more heavily with the bisphosphonate promotions. Tell them weight-bearing exercise and good veggies will do much more. Thanks for spreading the word!"

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