TNF Inhibitors Are Associated with Higher Risk for Melanoma in Rheumatoid Arthritis Patients

Absolute risk was small, but relative risk was increased by 50% in patients treated with tumor necrosis factor inhibitors.
Immune deficiency states, such as immunosuppression for organ transplantation, are associated with elevated risk for malignant melanoma. Although use of tumor necrosis factor α (TNF) inhibitors (e.g., infliximab [Remicade]) raises risk for opportunistic infections, whether their use is associated with excess risk for melanoma is unclear. In this population-based cohort study from Sweden, investigators evaluated the association between TNF inhibitor use and melanoma in patients with rheumatoid arthritis (RA).

Overall, 11,000 RA patients who had been treated with TNF inhibitors, 42,000 RA patients who were not treated with TNF inhibitors, and 163,000 matched controls from the general population participated in the study. Median follow-up was 4.8 years. First invasive melanomas developed in 38 TNF RA patients, in 113 non-TNF RA patients, and in 393 controls. Compared with controls, non-TNF RA patients were not at elevated risk for developing first invasive melanomas. However, risk was significantly elevated among TNF RA patients, compared with non-TNF RA patients (hazard ratio, 1.5). Risk was higher in men (HR, 2.7) than in women (HR, 1.2). Notably, TNF inhibitor use was not associated with excess risk for melanoma in situ or invasive cancers overall.

CITATION(S):

Raaschou P et al. Rheumatoid arthritis, anti-tumour necrosis factor therapy, and risk of malignant melanoma: Nationwide population based prospective cohort study from Sweden. BMJ 2013 Apr 8; 346:f1939.