Assessing cancer risk in patients using disease-modifying drugs and corticosteroids to treat rheumatoid arthritis

This study investigated the risk of skin cancer in patients taking disease-modifying drugs (DMARDs) and corticosteroids to treat rheumatoid arthritis (RA). They concluded that certain DMARDs and corticosteroids are associated with an increased risk of non-melanoma skin cancer.

Rheumatoid arthritis (RA) is a long-term, autoimmune disease. To treat painful swelling and inflammation in the joints, patients are prescribed medication to reduce inflammation. These drugs are called disease-modifying anti-rheumatic drugs (DMARDs). Corticosteroids are another type of medication given to patients, to reduce inflammation.

In order to reduce inflammation these medications suppress the body’s immune system. As a result, patients may be more susceptible to infection. Another condition they may be more susceptible to is cancer. Some evidence suggests that patients with RA may have an increased risk of non-melanoma skin cancer (NMSC).

This study investigated whether DMARDs or corticosteroids increases the risk of NMSC in patients with RA.

This study included information on 39,206 patients included in a national patient database. 19,603 patients were diagnosed with NMSC. Of these, 127 patients had RA. These patients were compared to 19,603 without a cancer history (controls), of which 53 had RA. Patient data was analysed to determine the factors that might influence cancer risk. Medication history, medical conditions (comorbidities), age, sex, and occupation information was analysed and compared.

Patients with RA had 2.23-times higher odds of developing NMSC. RA patients who had NMSC were on higher total medication doses compared to controls.

Medications that were associated with this increased risk included cyclosporine (5.7-times increased risk), etanercept (5.27-times), d-penicillamine (4.79-times), hydroxycholoroquine (2.29-times), sulfasalazine (2.26-times) and corticosteroids (2.32-times). Methotrexate was associated with a 2.01-times increased risk. Higher doses of therapies were associated with higher risk of NMSC. The risk increased further in patients over the age of 65.

Leflunomide and adalimumab were not associated with an increased NMSC risk.

The authors concluded that certain DMARDs and corticosteroids are associated with an increased risk of non-melanoma skin cancer.

This study was performed in a Taiwanese population, so the results may not extend to other ethnicities. It was a retrospective study, so some important patient information was not available. This could impact the results here as lifestyle factors, including smoking and alcohol consumption can also increase cancer risk.

If you have concerns regarding RA medications and cancer risk, please discuss with your physician.