TNF blockers

The US FDA first began investigating a potential link between TNF blockers and the development of blood cancers among children and adults back in 2008 after close to 200 cases of leukemia and lymphoma were reported in patients taking these medications (including 11 deaths). Their response was to include a black box warning on the medications warning people of the potential risk of developing a blood cancer from taking the medication.

In the spring of 2011, the FDA announced that it continues to receive reports of lymphomas developing in patients taking TNF blockers, although this time they specified an extremely rare and rather aggressive form of an incurable and hard-to-treat lymphoma known as hepatosplenic T-cell lymphoma (HSTCL),

T-cell lymphomas represent only about 15% of all non-Hodgkin's lymphomas reported annually; in general they are more difficult to treat and have a poorer prognosis than B-cell non-Hodgkin's lymphomas.

What are TNF blockers?

TNF stands for 'tumor necrosis factor', a protein that causes inflammation in the body.

TNF blockers are prescribed to treat various inflammatory and autoimmune disorders, including psoriasis, psoriatic arthritis, anklosing spondylitis, juvenile rheumatoid arthritis, ulcerative colitis, and Crohn's disease. These disorders involve an excess production of TNF within the body; TNF blockers therefore, also called TNF inhibitors, shut down the activity of TNF.

By blocking TNF, these drugs also suppress the immune system.

What are the more well-known TNF blockers?

The most widely prescribed TNF blockers include the following:

• Remicade
• Simponi
• Enbrel
• Humira
• Cimzia

However, the FDA is reporting that patients seemingly at higher risk of developing HSTCL are patients taking a TNF blocker along with another drug such as azathioprine, which also suppresses the immune system.

What is the cancer risk from taking TNF blockers?

It is impossible at this stage to determine what the cancer risk is from taking TNF blockers; an actual statistic may not be forthcoming for several years. Thus, each person should be made fully aware of the fact that the risk of developing cancer from these medications exists, and if the increased risk alone is worrisome, they should be presented with alternative treatment options.

Bottom line: this is a developing story. This is not the last word we will hear on the increased risk from these drugs, or the increased incidence of cancer among this patient population.

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