title: Melanoma risk in patients with rheumatoid arthritis treated with tumour necrosis factor alpha inhibitors: a systematic review and meta-analysis.
abstract: Clinicians are concerned that treatment of rheumatoid arthritis (RA) with tumour necrosis factor alpha antagonists (TNFα biologics) may increase patients' risk of melanoma compared with treatment with nonbiologic disease-modifying antirheumatic drugs (nbDMARDS). We aimed to assess the risk of melanoma in RA patients treated with TNFα biologics compared with RA patients treated with nbDMARDS. A secondary aim was to quantify the risk of melanoma in RA patients treated with TNFα biologics compared with the general population. We carried out a systematic review and meta-analysis searching Medline, Embase and the ISI Science Citation Index databases to January 2016. Cohort studies that enabled a quantitative assessment of the risk of melanoma in RA patients treated with TNFα biologics compared with either RA patients treated with nbDMARDS or the general population or both were included. Data were pooled using a random-effects model. From 812 articles, we identified six that fulfilled the inclusion criteria. Four studies reported on the risk of melanoma in RA patients treated with TNFα biologics compared with those treated with nbDMARDS, with a pooled effect estimate of 1.60 (95% confidence interval 1.16-2.19). Five reported on the risk of melanoma in RA patients treated with TNFα biologics compared with the general population, and the pooled effect estimate was 1.87 (95% confidence interval 1.53-2.30). There was no significant heterogeneity in either analysis. This systematic review and meta-analysis does not allay clinician's fears and, while awaiting further evidence from large collaborative studies, this patient population may benefit from regular skin checks and counselling to avoid excessive sun exposure.
authors.affiliation: aDepartment of Population Health, QIMR Berghofer Medical Research Institute, Herston, Australia bArthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, University of Manchester cNIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals Foundation Trust, Manchester Academic Health Science Centre dCancer Research UK Manchester Institute and Institute of Inflammation and Repair, University of Manchester, Manchester, UK.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Olsen
authors.forename: Kimme L
authors.initials: KL
authors.lastname: Hyrich
authors.forename: Lani L
authors.initials: LL
authors.lastname: Knight
authors.forename: Adèle C
authors.initials: AC
authors.lastname: Green
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D015331:Cohort Studies; D006801:Humans; D008545:Melanoma / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D014409:Tumor Necrosis Factor-alpha