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Riesgo de neoplasias malignas en pacientes con artritis reumatoide tratados con terapia biológica: un metanálisis

Maria A Lopez-Olivo¹, Jean H Tayar, Juan A Martinez-Lopez

¹University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.

|September 6, 2012

Resumen

Los modificadores de respuesta biológica (BRM) para la artritis reumatoide (AR) no mostraron un aumento en el riesgo de malignidad en ensayos controlados aleatorios. Este estudio no encontró una asociación significativa entre el uso de BRM y el desarrollo de cáncer en pacientes con AR.

Área de la Ciencia:

Reumatología Reumatología.
Oncología Oncología.
Los ensayos clínicos son ensayos clínicos.

Sus antecedentes:

Existen preocupaciones con respecto a posibles tumores malignos en pacientes con artritis reumatoide (AR) tratados con modificadores de la respuesta biológica (BRM).
La evaluación del riesgo de cáncer asociado con BRMs en AR es crucial para la seguridad del paciente y las decisiones de tratamiento.

Objetivo del estudio:

Evaluar el riesgo de malignidad en pacientes con artritis reumatoide (AR) que participan en ensayos controlados aleatorios (ECA) de modificadores de respuesta biológica (MBR).

Principales métodos:

Se realizó una búsqueda sistemática de ECA en bases de datos electrónicas, actas de conferencias y sitios web de agencias reguladoras.
Los ECA incluidos compararon los BRM para AR con placebo o medicamentos antirreumáticos tradicionales modificadores de la enfermedad (DMARD) con al menos 24 semanas de seguimiento.
La extracción de datos y la evaluación de la calidad se realizaron de forma independiente, con estimaciones agrupadas y intervalos de confianza calculados para cada BRM.

Principales resultados:

Se analizaron sesenta y tres ECA en los que participaron 29.423 pacientes con AR.
No se observó un aumento estadísticamente significativo en el riesgo general de cáncer maligno con el uso de BRM.
La incidencia de tumores malignos dentro del primer año de terapia fue baja en todos los grupos de BRM y controles, con un caso de anakinra más metotrexato mostrando probabilidades reducidas en comparación con el metotrexato solo.

Conclusiones:

El uso de BRMs en pacientes con AR dentro de ECA de al menos seis meses de duración no se asocia significativamente con un mayor riesgo de neoplasia maligna.
Los hallazgos sugieren que los BRM pueden usarse de manera segura con respecto al riesgo de cáncer en comparación con el placebo o los DMARD tradicionales en pacientes con AR.

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