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November 8, 2006

Risk of Serious Infections and Malignancies With Anti-TNF Antibody Therapy in Rheumatoid Arthritis

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;296(18):2201-2204. doi:10.1001/jama.296.18.2203-a

To the Editor: The meta-analysis by Dr Bongartz and colleagues1 examining the effect of anti-TNF antibody therapy on rates of malignancies in patients with RA highlights a critical issue pertaining to patients with chronic ulcerative colitis (CUC) who are receiving infliximab therapy for induction and maintenance.

Patients with CUC are at risk of dysplastic changes to their colonic mucosa, especially with extended duration of disease; those who receive immunosuppressive therapy for prior orthotopic liver transplants are at increased risk of developing colon cancer.24 Anti-TNF therapy, with its suppressive effect on both natural killer cell– and CD8 lymphocyte–directed tumoricidal function,1 may accelerate the development of colon cancer in patients with CUC. Isolated sites of colonic dysplasia can develop in CUC patients receiving maintenance therapy, and it is these sites of dysplasia that may be at especially high risk of malignant transformation with anti-TNF therapy.

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