Anti -TNF therapy and malignancy – A critical review: CONCLUSIONS
We have provided an analysis of the association between anti-TNF-a therapy and a possible increase in solid tumour and lymphoma development. At this time the database remains relatively small. Furthermore, the studies were clearly not powered to detect any causal relationship between anti-TNF-a therapy and a relatively rare event such as cancer. Analysis of the available data, however, does not provide evidence for a causal relationship. In fact, certain animal data suggest that suppression of TNF may actually protect against tumour development. In addition, clinical trial data have shown that anti-TNF-a therapy with infliximab does not change the number or function in vitro of cells of the immune system in contrast to other conventional immunosuppressive therapies. Furthermore, an extensive analysis of data surrounding infliximabtreated patients who developed malignancies indicated that the lymphoid malignancies rarely occurred and were invariably in patients with predisposing factors for malignancies such as NHL, including long standing inflammatory disease, severe disease and/or prior treatment with immunosuppressants such as azathioprine. Learn how to save money – cialis professional to enjoy your shopping and your treatment.
Together, the preclinical data and early clinical experience with infliximab do not provide evidence for a causal relationship between TNF-a antagonism and the development of lymphoid or nonlymphoid cancers. Our conclusions must be tempered by the fact that the randomized clinical trial database is small (including very few patients who only received placebo) and follow-up duration of all treated patients is still relatively short. Thus, all studies of this and other anti-TNF-a therapies possess limited power to detect a significant difference in malignancy incidence between patients receiving placebo and those receiving anti-TNF-a therapies. Data on larger numbers of patients followed long term are needed to establish the risk of cancer more accurately.