Hematologic Malignant Neoplasms After Drug Exposure in Rheumatoid Arthritis

Bernatsky, Sasha; Clarke, Ann E.; Suissa, Samy

doi:10.1001/archinternmed.2007.107

Cited by 117 publications

(67 citation statements)

References 18 publications

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“…Summary of evidence linked to recommendation. MTX/ DMARD -one nested case-control study examined the risk of incident lymphoma (not recurrence) in RA patients treated with MTX compared to RA patients treated with other DMARD and reported a small but not statistically significant increased risk associated with MTX (RR 1.23, 95% CI 0.97-1.57) 99 . In that study, no increased risk of lymphoma was associated with use of LEF, SSZ, antimalarials, or gold.…”

Section: Recommendation 11mentioning

confidence: 99%

Canadian Rheumatology Association Recommendations for the Pharmacological Management of Rheumatoid Arthritis with Traditional and Biologic Disease-modifying Antirheumatic Drugs: Part II Safety

Bombardier¹,

Hazlewood²,

Akhavan³

et al. 2012

J Rheumatol

124

147

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ABSTRACT. Objective. The Canadian Rheumatology Association (CRA) has developed recommendations for the pharmacological management of rheumatoid arthritis (RA) with traditional and biologic disease-modifying antirheumatic drugs (DMARD) in 2 parts. Part II, focusing on specific safety aspects of treatment with traditional and biologic DMARD in patients with RA, is reported here. Methods. Key questions were identified a priori based on results of a national needs-assessment survey. A systematic review of all clinical practice guidelines and consensus statements regarding treatment with traditional and biologic DMARD in patients with RA published between January 2000 and June 2010 was performed in Medline, Embase, and CINAHL databases, and was supplemented with a "grey literature" search including relevant public health guidelines. Systematic reviews of postmarketing surveillance and RA registry studies were performed to update included guideline literature reviews as appropriate. Guideline quality was independently assessed by 2 reviewers. Guideline characteristics, recommendations, and supporting evidence from observational studies and randomized trials were synthesized into evidence tables. The working group voted on recommendations using a modified Delphi technique.Results. Thirteen recommendations addressing perioperative care, screening for latent tuberculosis infection prior to the initiation of biologic DMARD, optimal vaccination practices, and treatment of RA patients with active or a history of malignancy were developed for rheumatologists, other primary prescribers of RA drug therapies, and RA patients. Conclusion. These recommendations were developed based on a synthesis of international RA and public health guidelines, supporting evidence, and expert consensus in the context of the Canadian health system. They are intended to help promote best practices and improve healthcare delivery for persons with RA. (First Release June 15 2012; J Rheumatol 2012;39:1583-602; doi:10.3899 Recommendations provided here are intended to be read in conjunction with the Canadian Rheumatology Association Recommendations for the Pharmacological Management of Rheumatoid Arthritis. These recommendations address specific safety questions that were identified a priori and are not intended to cover all safety aspects concerning treatment with traditional and biologic disease modifying antirheumatic drugs (DMARD).Traditional and biologic DMARD have greatly enhanced the care of persons with rheumatoid arthritis (RA); however, potential risks associated with their use need be considered. The Canadian Rheumatology Association (CRA) has developed recommendations for the pharmacological management of RA with traditional and biologic DMARD in 2 parts. Part I described the development process of CRA recommendations in detail and included 5 overarching RA care principles along with 26 treatment recommendations 1 . Part II, reported here, focuses on specific safety aspects of treatment with traditional and biologic DMARD in patients with ...

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Section: Recommendation 11mentioning

confidence: 99%

Canadian Rheumatology Association Recommendations for the Pharmacological Management of Rheumatoid Arthritis with Traditional and Biologic Disease-modifying Antirheumatic Drugs: Part II Safety

Bombardier¹,

Hazlewood²,

Akhavan³

et al. 2012

J Rheumatol

124

147

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“…Some studies actually suggest that MMF may reduce malignancy risk in these populations. Although some data have associated azathioprine use with malignancies in rheumatoid arthritis (36), these data are controversial (37), and no such link has been established in AAV or lupus. The long-term follow-up of the preceding trials will be important in better defining long-term malignancy risks for the current first-line treatment regimens in AAV and lupus nephritis.…”

Section: Malignanciesmentioning

confidence: 99%

Is Newer Safer? Adverse Events Associated with First-Line Therapies for ANCA-Associated Vasculitis and Lupus Nephritis

Hogan

Avasare

2014

Clinical Journal of the American Society of Nephrology

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Clinical outcomes in ANCA-associated vasculitis (AAV) and lupus nephritis have improved greatly with treatment regimens containing high-dose glucocorticoids and cyclophosphamide. However, with the use of these medications come significant adverse events, most notably infections, cytopenias, malignancies, and reproductive abnormalities. Multiple recent randomized controlled trials in AAV and lupus nephritis have compared cyclophosphamide-based regimens with agents such as rituximab, mycophenolate mofetil, and azathioprine, with the hope of providing better clinical outcomes with improved safety profiles. Although some of these newer regimens are now considered first-line treatments of these diseases, their adverse event profiles have been disappointingly similar to those of cyclophosphamide-based protocols. Physicians and patients should consider the adverse event profiles generated by these trials in the context of their extensive use in other patient populations, as well as available measures to prevent such events, when choosing the ideal regimen for an individual patient.

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“…As RA itself may slightly increase the risk for lymphomas, it is difficult to assess whether MTX treatment would favorably or unfa-vorably affect the association of lymphoproliferative diseases with RA. Yet, sustained clinical activity of RA may be the primary risk factor for secondary malignancies and MTX may have a net beneficial effect in this respect [32][33][34] .…”

Section: Traditional Immunosuppressive Drugsmentioning

confidence: 99%

Malignancies in Autoimmune Rheumatic Diseases – A Mini-Review

Szekanecz

Bakó

et al. 2010

Gerontology

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Paraneoplastic symptoms, caused by a malignancy, but not directly related to invasion by the tumor or its metastases, are the result of a wide variety of tumor-derived biologic mediators like hormones, peptides, antibodies, cytotoxic lymphocytes, autocrine and paracrine mediators. Systemic inflammatory rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma or dermatomyositis, may increase the risk for the development of malignancies, predominantly lymphoproliferative disorders. Immunosuppressive drugs and biological agents may also be carcinogenic. However, sustained inflammatory activity seems to be the primary risk factor for malignancies in autoimmune diseases. Tumor-associated antigens may be produced by inflammatory cells and their production may be increased in rheumatoid arthritis and other autoimmune diseases.

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Hematologic Malignant Neoplasms After Drug Exposure in Rheumatoid Arthritis

Cited by 117 publications

References 18 publications

Canadian Rheumatology Association Recommendations for the Pharmacological Management of Rheumatoid Arthritis with Traditional and Biologic Disease-modifying Antirheumatic Drugs: Part II Safety

Canadian Rheumatology Association Recommendations for the Pharmacological Management of Rheumatoid Arthritis with Traditional and Biologic Disease-modifying Antirheumatic Drugs: Part II Safety

Is Newer Safer? Adverse Events Associated with First-Line Therapies for ANCA-Associated Vasculitis and Lupus Nephritis

Malignancies in Autoimmune Rheumatic Diseases – A Mini-Review

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