Rheum Arthritis patient greater risk for Cancers

Cancer Risk 50% Greater in Treated RA Patients Than in General Population

By: SARA FREEMAN, Internal Medicine News Digital Network

04/27/11

FROM THE BRITISH SOCIETY FOR RHEUMATOLOGY ANNUAL CONFERENCE

Major Finding: Standardized incident ratios for NHL, lung cancer, and colorectal cancer were 3.73, 2.71, and 0.96, respectively, comparing RA patients treated with nonbiologic DMARDs with the general population.

Data Source: Six-year, prospective follow-up of 3727 patients with nonbiologically treated RA enrolled in the British Society for Rheumatology Biologics Register (BSRBR).

Disclosures: The BSRBR is funded by a grant from the British Society for Rheumatology (BSR). The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme Limited, Pfizer, Roche and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and run the BSRBR. All decisions concerning data analysis, interpretation and publications are made autonomously of any industrial contribution. Dr. Mercer and Dr. Symmons declared that they had no personal conflicts of interest.

BRIGHTON, ENGLAND – The risk of cancer is almost 50% higher in people with rheumatoid arthritis who are treated with nonbiologic agents when compared to the general population, according to data just released from the British Society for Rheumatology Biologics Register.

Although the link between rheumatoid arthritis (RA) and malignancy has been previously identified – particularly with respect to a higher risk of non-Hodgkin’s lymphoma (NHL) – these new data from the British Society for Rheumatology Biologics Register (BSRBR) are from a more-contemporary population of patients who have been treated in the era of widespread use of methotrexate (MTX) and other nonbiologic disease-modifying antirheumatic drugs (DMARDs).

Dr. Eric L. Matteson, who is a professor of medicine at the division of rheumatology at the Mayo Clinic, Rochester, Minn., noted in an interview that the registry findings seem to indicate that overall cancer risk is increased in patients with RA and that this risk is similar in patients exposed to biologics and nonbiologics, with the exception that nonmelanoma skin cancer appears to be somewhat more frequent in the biologics treated patients.

"I think the conclusions arrived at are consistent with previous studies and so not surprising regarding nonbiologics, in particular, methotrexate. A study from Australia by Dr. Rachelle Buchbinder, for example, already reported in 2008 an almost identical finding of 50% increased risk of cancer in patients with RA treated with methotrexate."

There was an estimated 50% excess risk of malignancy among RA patients exposed to MTX relative to the general population (standardized incidence ratio, 1.5; 95% confidence interval, 1.2-1.9). In that study, the risk of non-Hodgkin’s lymphoma was more than five times higher in RA patients than in the general population (SIR, 5.1; 95% CI 2.2-10.0). Other cancers for which there was evidence of increased risk were lung cancer (SIR, 2.9; 95% CI 1.6-4.8) and melanoma (SIR, 3.0; 95% CI 1.2-6.2). (Arthritis Care Res. 2008;59:794-9).

Dr. Matteson qualified his remarks by noting that he did not hear the presentation and assumes methotrexate was the comparator drug.

In reporting the findings, Dr. Louise Mercer, a clinical research fellow at the Arthritis Research UK Epidemiology Unit, University of Manchester, England, where the BRSBR is coordinated, on April 13 at the British Society for Rheumatology Annual Conference (Rheumatology 2011;50:iii37-8, abstract OP18) noted that they set a baseline for analyzing the cancer risk of biologic therapy, compared with conventional RA therapy within the BSRBR patient population – the primary reason the register was set up 10 years ago.

The analysis included 3,727 RA patients treated with nonbiologic DMARDS who were enrolled in the register between 2002 and 2008. Data from the national cancer registry for England and Wales provided information about whether or not they developed cancer. SIRs were used to compare the observed vs. the expected number of cancers and were adjusted for age and gender.

Of 148 malignancies occurring in 10,447 patient-years, 128 were solid cancers – including melanoma, and lung, breast, and colorectal cancers – and 20 were hematologic – including NHL and Hodgkin’s lymphoma. The median time from enrollment in the register to cancer diagnosis was 1.3 years, with 52% of patients dying as a result of incident cancer.

The standardized incidence ratio for all cancers was 1.48. Looking at specific types of malignancy, the highest SIR was recorded for NHL, at 3.73, although the risk of lung cancer was also substantial, with a SIR of 2.71. The SIR for colorectal cancer was 0.96.

Considering these findings, "vigilance for cancer, especially lung cancer and lymphoma should be maintained," Dr. Mercer advised.

"Our experience is that all cancers were increased by about 48%, with quite a marked increase in NHL and lung cancer, said Dr. Deborah Symmons, during a separate presentation at the meeting. An interesting finding, she noted, was that any benefit of NSAID drugs used to treat RA in lowering the risk of colorectal cancer appeared to be "wearing off."

Dr. Symmons, also of the Arthritis Research UK Epidemiology Unit in Manchester and a principle investigator for the BSRBR, explained that this adds to the evidence that, "the cancer risk in our general rheumatoid population is increased for some cancers."

These data are of interest, as they will eventually be used to compare the cancer risk of biologic vs. nonbiologic DMARDs. Such analysis is unlikely to be undertaken any time soon, however, as it is planned to occur when 20,000 years of patient follow-up have been accumulated. To date, there has been no signal that an earlier analysis is warranted.

"In the [anti-TNF] clinical trials, most of which were less than a year [in duration] there was not an increase in cancer except for [nonmelanoma skin cancer]," Dr. Symmons observed. "The cancer risk in observational studies is not increased in the short term," she added, "but we still don’t know what the long-term risk might be."

Echoing her comments were the separate findings of a Wyeth-sponsored study presented as a poster at the meeting. Dr. Peter Taylor of the Kennedy Institute of Rheumatology in London and his associates looked at the risk of malignancy associated with TNF inhibitors in registries and prospective observational studies. They reported a pooled-risk estimate of 1.11 for lymphoma, 1.45 for nonmelanoma skin cancer, and 1.79 for melanoma comparing TNF-treated patients with nonexposed RA patients.

Dr. Taylor and his team said of their findings: "This systematic review and meta-analysis provide reassurance to physicians and patients that treatment of RA patients with TNF inhibitors does not increase the risk of malignancy in general, or of lymphoma in particular, but does appear to increase the risk of skin cancer, including melanoma."

The systemic review and meta-analysis was sponsored by Wyeth. Dr. Taylor has received research grants and honoraria from Abbott, Bristol-Myers Squibb, Pfizer, Roche, Schering-Plough, and UCB. The BSRBR is funded by a grant from the British Society for Rheumatology. The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme Ltd., Pfizer, Roche, and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and run the BSRBR. All decisions concerning data analysis, interpretation and publications are made autonomously of any industrial contribution.

Dr. Mercer, Dr. Symmons, and Dr. Matteson declared that they had no personal conflicts of interest.

NonEsterified Fatty Acids (NEFA)

Nonesterified Fatty Acid Level: A New Risk Factor for Sudden Death

[Dr. Saleeby's note: We check NEFA or FFA (Free Fatty Acids) as part of our Wellness Profile advanced blood testing]

Fewer than 10 percent of sudden cardiac death episodes are aborted. To explore prevention strategies, these researchers studied the role of circulating nonesterified fatty acids (NEFA), also called free fatty acids, in sudden death. NEFA are released from adipose tissue and have arrhythmogenic properties in animal models; in humans, NEFA may be linked with post-MI ventricular arrhythmias. Is high NEFA concentration a risk factor for sudden death in middle-aged men without known cardiovascular disease?

Researchers analyzed data from the Paris Prospective Study I, which enrolled 7746 French men (age range, 42 to 53) from 1967 through 1972. At baseline, each participant provided demographic information and underwent a physical exam, an electrocardiogram, and blood testing. At 1 year, a second physical exam was performed and blood samples were obtained to determine fasting NEFA levels. A total of 5250 participants who were free of ischemic heart disease at enrollment were followed for a mean of 22 years.

During follow-up, 1601 deaths occurred, including 91 sudden deaths and 145 fatal MIs. Multivariate analysis revealed that sudden death was predicted independently by increases of 1 standard deviation in NEFA concentration (relative risk, 1.7), body-mass index, systolic blood pressure, tobacco use, parental history of sudden death, and cholesterol level. Sudden-death risk increased progressively with increasing NEFA concentration. Notably, NEFA concentration did not predict fatal MI.

Comment: Although this large study's results identify circulating NEFA as a risk factor for sudden cardiac death, the risk was continuous, with no clear threshold for identifying high-risk patients. Still needed are studies that (1) assess how NEFA concentration contributes to sudden-death risk in clinical practice and (2) determine whether dietary supplementation of polyunsaturated fatty acids, which reduce NEFA levels and have an antiarrhythmic effect, are effective preventive therapy for patients with high NEFA levels. As an editorialist notes, a dietary balance between ${omega}$ -6 fatty acids (found in plant-seed oils) and ${omega}$ -3 fatty acids (found in fish oil) is needed for effective prevention. Most Americans' diets include many more ${omega}$ -6 than ${omega}$ -3 fatty acids, an imbalance that the American Heart Association's recent recommendation for eating fish twice weekly may help to correct.

— H Calkins

[Actually the American diet has plenty of n-6FA, but we do need more n-3FA or fish oil or fish in our diet. WellnessPRIME has two types of n-3FA available, both are molecularly distilled and PURE, inquire at front desk]

Published in Journal Watch Cardiology November 9, 2001.

CITATION(S):

Jouven X et al. Circulating nonesterified fatty acid level as a predictive risk factor for sudden death in the population.Circulation 2001 Aug 14 104 756-761.

Walk this way

Today was the inaugural "Walk with the Doc" program launched by Wellness One for patients and the public. We utilized the walking path around the Market Commons Lakes. It was a most beautiful morning to be out breathing in fresh air and getting our pulse rate up. Dr. Saleeby and Dr. Thomas lead a small group of participants. All those who attended received WellnessOne T-shirts. Keep your eyes open for flyers announcing the next (and regular) walk with your doctor outings. They will be announced at the center and in our newsletter and calendar of events online.

Health Diagnostics Lab Seminar

Dr. Saleeby, Kristin, Kelly and Lindsy

Furthering our Medical knowledge in the ways of Advanced Diagnostic Genomic and Lipid analysis, Wellness One and Wellness First doctor and staff attend a seminar in Charleston. Lots is learned and will be shared with our patients on ways to improve health, limit disease and live longer. Pictured (L-R) is Dr. Saleeby, Kristen (future PA at WO), Kelly (RN at WO), Lindsy (MA/Phlebot at WF).

Organic: To Eat or Not To Eat?

“Health halo” effect of organic food labeling may mislead consumers

Springer Healthcare
Apr 4, 2013
Note from Dr. Saleeby: Just remember ORGANIC food is NOT necessarily BETTER for you or your wallet. Also something labeled "Made with 90% Organic Ingredients"... is NOT entirely organic, don't be tricked by fancy labeling.

medwireNews: Many people consider food products to taste healthier and contain fewer calories if they are labeled as organic, suggest study findings.

The researchers, led by Mitsuru Shimizu (Cornell University, Ithaca, New York, USA), found that this "health halo" organic label-associated effect occurred despite comparison foods also being organic, and of identical origin and appearance to the foods labeled as organic.

The findings extended to price and the team found that participants were willing to pay almost a quarter more for food products labeled as being organic than for those not labeled as organic, regardless of taste and origin.

However, people who regularly read nutritional labels, often bought organic foods, and participated in pro-environmental activities were significantly less likely to assume that organic food contained less calories than people who did not.

As reported in Food Quality and Preference, Shimuzu and colleagues randomly recruited 115 people aged 16-76 years from a shopping mall in Ithaca over a 2-day period. The participants' body mass index ranged from 16.4 to 55.8 kg/m2.

Each participant was asked to taste and assess three paired food samples consisting of cookies, potato chips, and yoghurt. Although the two samples were identical and both sourced from an organic producer, only one sample in each pair was labeled as organic.

People rated the organically labeled samples as containing significantly fewer calories than the unlabeled samples. For example, they estimated that the organic cookies contained an average of 144.93 calories versus 191.07 for the unlabeled cookies.

The participants also rated the organically labeled products as tasting significantly more nutritious, lower in fat, lower in calories, and higher in fiber than the unlabeled samples.

Regarding price, participants said they would be willing to pay 22.8%, 23.4%, and 16.1% more for organic yoghurt, potato chips, and cookies than for non-organic products.

"The use of organic labels on processed food items may seem attractive to retailers and manufacturers in order to advocate the benefits of organic methods of production. However, this study demonstrates that these labels may instead impart an undue perception of increased healthfulness of a food item," write the authors.

"Given the disparity between the intended message and actual consumer perception, more caution should be taken in determining whether and how the organic label - as well as other health claims - should be included on a given food package."

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Helen Albert, Senior medwireNews Reporter source: http://www.merckmedicus.com/medical-news/182a3fac5a34e8042918de6545b650c1

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