Rheumatology News Roundup: Methotrexate-Skin Cancer Rates

Fatigue Still Persists Long After Arthritic Flares Subside:  The therapeutic management of rheumatoid arthritis (RA) has changed over the past 30 years largely due to the introduction of biologics and the adoption of methotrexate as the primary treatment. Yet, patients are still presenting with high BMIs and more comorbidities. A study published in Rheumatology examines trends in clinical and patient-reported outcomes in early RA.

The study included 2,701 patients and compared the five-year progression rates of clinical and patient-reported outcomes for patients diagnosed with RA in 1990, 2002 and 2010. It included clinical markers DAS28 and ESR. HAQ, visual analogue scale of pain and global health, and the Short-Form 36 were included as the patient-reported markers in the study.

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Study Confirms Skin Cancer Risk with Methotrexate:  A double-blind, placebo-controlled, randomized clinical trial has confirmed that low-dose methotrexate is associated with an increased risk of skin cancer, according to a study published this week in the Annals of Internal Medicine. Of 2,391 participants assigned to low-dose methotrexate, 2,080 (87.0%) experienced an adverse event compared to 1,951 of 2,395 (81.5%) patients assigned to placebo (hazard ratio [HR], 1.17 [95% CI, 1.10 to 1.25]).

The risk of all-cause adverse events for this well-established treatment was about 30 percent more for patients receiving low-dose methotrexate compared to the placebo group. Liver function abnormality was about two-fold more common in the treatment group; nausea, vomiting and diarrhea was 50 percent more prevalent; pulmonary adverse events of any type were increased; interstitial pneumonitis increased seven-fold in the treatment group and anemia was more common in the treatment group.

With the exception of increased risk for skin cancer (HR, 2.05 [CI, 1.28 to 3.28]), the treatment groups did not differ in risk for other cancer or mucocutaneous, neuropsychiatric, or musculoskeletal AEs. Renal AEs were reduced in the LD-MTX group (HR, 0.85 [CI, 0.78 to 0.93]).

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Psoriasis Cancer Prevalence is 4.7% New Research Shows:  A systematic review and meta-analysis published today in JAMA Dermatology confirms that psoriasis patients have a slightly increased risk of cancer, specifically, keratinocyte cancer and lymphomas. This study is based on an analysis of 112 studies from PubMed and Embase that included 2.5 million patients. The overall prevalence of cancer in psoriasis patients within this group was 4.7 percent (95% CI, 4.02%-5.59%). The incidence rate of cancer was 11.75 per 1,000 person years (95% CI, 8.66-15.31) and the risk ratio (RR) was 1.21 (95% CI, 1.11-1.33).

The most common cancers were keratinocyte cancer (RR, 2.28; 95% CI, 1.73-3.01), lymphomas (RR, 1.56; 95% CI, 1.37-1.78), lung cancer (RR, 1.26; 95% CI, 1.13-1.40), and bladder cancer (RR, 1.12; 95% CI, 1.04-1.19). There was no increased risk of cancer identified among psoriasis patients who were treated with biologics (RR, 0.97; 95% CI, 0.85-1.10). Psoriatic arthritis was not associated with increased risk of overall cancer (RR, 1.02; 95% CI, 0.97-1.08), but this may be due to to a lack of data.

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Long-Term TNFi Use in Axial Spondyloarthritis May Slow Radiographic Progression:  Long-term use of tumor necrosis factor inhibitors (TNFi) may show radiographic progression benefit in axial spondyloarthritis, say researchers recently writing in Arthritis & Rheumatology.

This was a systematic review and meta-analysis of 24 axial spondyloarthritis that included 18 studies focused on TNFi treatment, eight on non-steroidal anti-inflammatory drugs (NSAIDs) and one secukinumab. Spinal radiographic progression was not significantly different among TNFi-treated versus biologic naïve populations at two years, but there was a difference at four years. No significant differences were observed in NSAID or secukinumab treated groups.

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