Incidence of melanoma and other malignancies among rheumatoid arthritis patients treated with methotrexate

Abstract

Objective. To determine cancer risk in a cohort of 459 rheumatoid arthritis (RA) patients treated with methotrexate in community practice. Methods. All RA patients who started methotrexate prior to June 1986 and were attending 1 of 6 rheumatologists were studied. Demographic data were matched to the State Cancer Registry to identify all malignancies (except nonmelanoma skin cancer) for 1983-1998, and to the National Death Index to identify all deaths to the end of 1999. Followup started on the date when methotrexate was started and ended either on the last confirmed date on which the patient was seen by the rheumatologist or at death. Standardized incidence ratios (SIRs) were calculated using state population cancer rates stratified by sex, age (in 5-year groups), and calendar year. Results. There were 4,145 person-years of followup (average 9.3 years). Eighty-seven malignancies were identified (14 before, 64 during, and 9 after the followup period). There was an estimated 50% excess risk of malignancy among methotrexate-exposed RA patients relative to the general population (SIR 1.5, 95% confidence interval [95% CI] 1.2-1.9), with a 3-fold increase in melanoma (SIR 3.0, 95% CI 1.2-6.2), a 5-fold increase in non-Hodgkin's lymphoma (SIR 5.1, 95% CI 2.2-10.0), and an almost 3-fold increase in lung cancer (SIR 2.9, 95% CI 1.6 -4.8). Conclusion. Compared with the general population, methotrexate-treated RA patients have an increased incidence of melanoma, non-Hodgkin's lymphoma, and lung cancer. There may be a role for regular skin cancer screening for all RA patients, particularly those receiving immunosuppressive therapy.

Cutaneous Melanoma Is Related to Immune Suppression in Kidney Transplant Recipients

“…The excess risk may also extend to patients receiving immune-modifying agents for other conditions. Indeed, an increased incidence of melanoma has recently been observed in rheumatoid arthritis patients treated with methotrexate (47,48). Although immune dysregulation related to the rheumatoid arthritis may have played a role in this finding, an elevated incidence of melanoma was not observed in large-scale population-based studies of rheumatoid arthritis patients prior to the use of such agents (49,50).…”

Immune Phenotype Predicts Risk for Posttransplantation Squamous Cell Carcinoma

“…Patients who require regular oral steroid therapy and rheumatoid arthritis patients who take disease-modifying agents have a two to four times increased risk for SCC compared with the general population. 6,7 In comparison, OTRs have up to a 200 times increased risk for SCC compared with the general population. 8 Three percent of OTRs will require extensive plastic surgical procedures per year.…”

Diffuse Large B Cell Lymphoma Secondary to Rheumatoid Artritis: Case Report

“…The authors have also postulated that the observed increased lymphoma incidence may reflect channeling bias that is, channeling of high risk patients to DMARD treatment. 8 Rituximab is a genetically engineered chimeric monoclonal antibody that targets CD20 positive B cell. Food and Drug Administration (FDA) has approved it for the treatment of relapsed or refractory, low-grade or follicular CD20 positive B-cell NHL and for diffuse, large B-cell CD20 positive NHL in combination with approved chemotherapy.…”