Review of united states data on neoplasms in rheumatoid arthritis

Castor, C. William; Bull, Frances E.

doi:10.1016/0002-9343(85)90243-8

Cited by 28 publications

(9 citation statements)

References 16 publications

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“…Multiple previous studies support these findings in patients who have been treated with azathioprine chronically for rheumatoid arthritis and inflammatory bowel disease [85][86][87][88][89].…”

Section: Systemic Immunosuppressive Therapy For Eye Disease Studysupporting

confidence: 56%

Corticosteroid-Sparing Agents: Conventional Systemic Immunosuppressants

Kruh

Foster²

2012

Developments in Ophthalmology

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The introduction of corticosteroids in the mid-20th century to control inflammatory eye disease revolutionized treatment practices. As long-term use of corticosteroids became the backbone of immunosuppressive therapy, it soon became evident that it was associated with significant morbidity to the patient. For this reason, other immunosuppressant agents were sought. Thereafter, the first generation of immunosuppressive agents were born. The main action of all such agents involves the inhibition of lymphoid proliferation. The agents can be further subdivided into the following categories based on their specific mechanism of action: alkylating (cyclophosphamide and chlorambucil), antimetabolite (methotrexate, mycophenolate mofetil and azathioprine), and antibiotic/calcineurin inhibitor (cyclosporine, tacrolimus and sirolimus). These immunomodulating agents serve as the foundation to modern corticosteroid-sparing immunosuppressive therapy. Many times, these agents are now even indicated as first-line therapy for the treatment of systemic inflammatory diseases with destructive ocular sequela, e.g. Behçet's disease and granulomatosis with polyangiitis (Wegener's). Choosing the most appropriate immunomodulatory agent to initiate therapy can often be difficult; a multifactorial approach in the decision-making process is essential. Special attention must be given to the patient's medical history, type and severity of inflammatory disease, social history, compliance, age, and sex. Oftentimes, it takes a joint effort between the ophthalmologist and multiple sub-specialists (rheumatology, oncology, and hematology) to administer and monitor these therapies. Even though each of these systemic immunosuppressive agents has its own array of potential side effects, with careful monitoring and titration of dosages, such potential side effects can be minimized or avoided altogether. Ultimately, these patients are afforded a much more favorable longterm outcome, free of the devastating effects of chronic corticosteroid use.

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Section: Systemic Immunosuppressive Therapy For Eye Disease Studysupporting

confidence: 56%

Corticosteroid-Sparing Agents: Conventional Systemic Immunosuppressants

Kruh

Foster²

2012

Developments in Ophthalmology

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“…Gastrointestinal side effects, like nausea, vomiting and hepatotoxicity, are also frequent but easily managed by dosage adjustment. In addition, azathioprine may increase the patient's risk to develop neoplasia, even though data defining the precise risk for malignancy are discongruent [32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Azathioprine as an alternative treatment in primary hypophysitis

et al. 2010

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Primary hypophysitis (PH) is an unusual disorder characterized by inflammatory infiltration of the pituitary gland with various degree of pituitary dysfunction. Glucocorticoids are the treatment of choice in the majority of patients. Still, in patients with poor response in glucocorticoids or when their administration is accompanied with serious side effects, the use of alternative agents should be considered; up to now, data on other therapeutic approaches remains scant mainly due to the rarity of the disease. Among them, the immunosuppressant azathioprine could represent an effective and safe alternative. In this article, we present our clinical experience of two cases with PH successfully treated with azathioprine following serious side effects after initial treatment with glucocorticoids and provide a brief review of the existing literature.

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“…3 28 This increased incidence of lymphomas in rheumatoid arthritis could explain the appearance of lymphomas in rheumatoid patients treated with methotrexate. Another argument against a causative role of methotrexate is that it did not augment the frequency of sister chromatid exchange (a sensitive method of detecting the mutagenicity of a molecule) in eight psoriasis patients treated for two to 10 months 29…”

Section: Discussionmentioning

confidence: 99%

Study of eight cases of cancer in 426 rheumatoid arthritis patients treated with methotrexate

Bologna

Picot

Viu

et al. 1997

Annals of the Rheumatic Diseases

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Objective-To report cancer cases in 426 rheumatoid arthritis patients treated with methotrexate, and determine whether there was an increased incidence of cancer compared with patients never treated with methotrexate (rheumatoid controls) and to the whole regional population. Methods-The duration of methotrexate treatment was 37.4 (SD 27.9) months. This population was compared with 420 rheumatoid arthritis controls and with a regional population of 812 344 people. Life table analysis was performed to compare the cancer incidence in the two rheumatoid populations. Adjustment for potentially confounding factors was done. The indirect standardisation method was used to compare each rheumatoid population with the regional population. Results-Eight cases of cancer (1.88%; 4.04 cases/1000 person years) were diagnosed in the methotrexate population v six (1.43%; 58.8 cases/1000 person years) in the rheumatoid controls. The life table method showed a higher incidence of cancer in the rheumatoid controls (P = 0.0001). In a multivariate analysis (Cox model), the only significant factor explaining this diVerence in the cancer incidence was age (P = 0.02). In the regional population there were 6418 new cases of cancer (0.79%; 2.85 cases/1000 person years). By the indirect standardisation method, the ratio of observed cases to expected cases of cancer in each of the rheumatoid populations was not significantly diVerent from 1. Conclusions-In these eight cases, methotrexate was not found to be responsible for generating cancers. However, because of data regarding lymphomas and methotrexate, and because of the short follow up, especially in the control group, longer prospective studies are warranted.

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Review of united states data on neoplasms in rheumatoid arthritis

Cited by 28 publications

References 16 publications

Corticosteroid-Sparing Agents: Conventional Systemic Immunosuppressants

Corticosteroid-Sparing Agents: Conventional Systemic Immunosuppressants

Azathioprine as an alternative treatment in primary hypophysitis

Study of eight cases of cancer in 426 rheumatoid arthritis patients treated with methotrexate

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