Ron G:

Best---
Ron

http://www.fda.gov/medwatch/SAFETY/2004/safety04.htm#procrit

ME:

Wasn't this the study that Harvey (I think) referenced?  The "control
group" had NO immune suppressed people, so it may have been skewed
based on that.  Am I thinking of a different study?  Somebody help me
out.

Smokie Darling (Annie)

Hooray for Remicade best drug I have ever taken.  RA causes an
increase in Lymphoma,  many folks think the increase in Lymphoma is
due to the fact that more severe patients are on it and more severe
patients are prone to Lymphoma.  Are you on the drug?  Ra is a very
serious disease and should be treated seriously.  -- MZ

Visit my website:
http://www.mzuschlag.com

Chicken Little, what does procrit being used to treat cancer have
to do with Remidade and arthritis?

here from the John Hopkins website:
Anti-TNF and
Malignancy
The immune system has an important role in surveillance for
malignancy, and the role of TNF , in particular, in triggering
apoptosis of some tumor cell types has already been noted. Thus, an
increased risk of malignancy is of theoretical concern with chronic
long-term TNF inhibition. Unfortunately, short-term clinical trials
cannot adequately address this question. At 3-year follow-ups of
patients treated with TNF inhibitors in clinical trials, however, no
apparent increase in the rate or type of malignancies has surfaced
yet. However, definitive answers to the risk of malignancy await
long-term treatment data in a wider population. Registries have been
established to collect these data.

here is the study on Lymphoma and Anti-tnf .  Note the comments at the
end this is quoted from the John Hopkins website I did not write it.

" Likewise, the mild increase in lymphoma incidence in the TNF
antagonist treated patients could be explained by more severe disease
which is a known risk factor for lymphoma in RA"

So before everyone decides the Anti-TNFs will give you cancer remember
that the studies are not always a simple cause and effect. -- MZ

http://hopkins-arthritis.org/edu/acr2003/ra-treatments.html
quoted below:

Abstract 543 Lymphoma in Rheumatoid Arthritis: the Effect of
Methotrexate and Anti–TNF Therapy in 18,572 Patients.
Wolfe and Michaud

Background: The risk of lymphoma is increased in patients with
rheumatoid arthritis (RA). It remains unclear whether treatment with
methotrexate or TNF inhibitors is associated with an increased risk
for developing lymphoma in RA patients. Previous studies (prior to the
anti-TNF era) have shown strong correlations between disease activity
and lymphoma development. This study was undertaken to determine the
rate and standardized incidence ratio (SIR) for lymphoma in RA
patients, and in subsets of patients by treatment group. In addition,
the investigators sought to determine predictors of lymphoma in RA.

Methods: A prospective study of 18,572 RA patients who were surveyed
biannually in a long-term outcome study (1998-2002). Potential
lymphoma cases received detailed follow-up. The SIR was calculated
with data from the SEER cancer data resource.

Results: Twenty-nine (29) cases of lymphoma were identified, yielding
a rate of 98.9 per 100,000 patient years of observation. The following
SIR rates were observed/calculated:

1.9 (95% C.I. 1.3, 2.7), overall
2.9 (1.7, 4.9), for biologic use  
2.6 (1.4. 4.5), for infliximab, with or without etanercept
3.8 (1.9, 7.5), for etanercept, with or without infliximab
1.7 (0.9, 3.2), for MTX
1.0 (0.4, 2.5), for those not using MTX or biologics

Lymphoma was associated with increasing age (hazard ratio 1.58 per 10
year increase (95% C.I. 1.16, 2.18), male sex (HR 3.70 (1.79, 7.68))
and education (1.16 (0.99, 1.37)), but not with current or previous
therapy. There was no temporal pattern for the development of lymphoma
after the start of anti-TNF therapy. A wide variety of lymphoma cell
types were identified. Patients receiving anti-TNF therapy had more
severe RA at enrollment than did non anti-TNF patients.

Conclusion: The incidence of lymphomas is increased in RA, but
confidence intervals overlap among all treatment groups. The apparent
increase in lymphomas in patients treated with TNF inhibitors may be
due to confounding by indication — that is, that patients with severe
disease who are (historically) most likely to develop lymphomas are
also the ones most likely to receive TNF inhibitors.

Editorial Comment: There has been significant concern as to whether
TNF inhibitors increase an RA patient’s risk for developing lymphoma.
Defining this risk accurately has been difficult. To date, incidence
rates for lymphomas in TNF antagonist-treated patients have been
compared to contemporaneous non-RA controls, or to historical RA
controls, due to lack of data in contemporaneous RA controls not
receiving TNF antagonists. The validity of these comparisons is
questionable. Dr. Wolfe herein provides the first estimates of
lymphoma rates in a prospective cohort of RA patients, some of whom
received TNF antagonists and some who did not. Interestingly, the
patients who were not receiving MTX or TNF antagonists did not exhibit
a higher incidence of lymphomas compared to the SEER data base
controls, perhaps reflecting milder disease. Likewise, the mild
increase in lymphoma incidence in the TNF antagonist treated patients
could be explained by more severe disease which is a known risk factor
for lymphoma in RA


Visit my website:
http://www.mzuschlag.com