Dr. Timothy Beukelman, a pediatric rheumatologist, has been looking at the safety of a group of drugs that are successfully used to treat children with juvenile idiopathic arthritis (JIA). One of his current research projects, called “Tumor Necrosis Factor (TNF) Inhibitors and the Risk of Malignancy in the Treatment of JIA”, was presented at the 2016 ACR conference in Washington, DC.
In 2009, the FDA issued a warning about TNF inhibitors. It stated there could be an increased risk of cancer in children and teenagers who use these drugs to treat JIA and other inflammatory diseases.
Dr. Beukelman said that the FDA analyses did not take into account the chance for increased risk from other drugs used to treat JIA or an increased risk from the disease itself. “The TNF inhibitors have made a tremendous difference for children with arthritis,” Dr. Beukelman said. “Because of these drugs, children who would have been previously confined to wheelchairs can now play in sports with their friends who do not have arthritis. The benefits of these drugs are obvious to patients who take them. I wanted to study the risks to make sure the drugs are safe.”
Dr. Beukelman is the Scientific Director of the Childhood Arthritis and Rheumatology Research Alliance (CARRA), an Arthritis Foundation-funded partner. The partnership (and this study) strive to answer the questions we hear most frequently (like are these drugs safe? what makes one drug work better than another?).
This study used medical insurance claim billing records from 2000 to 2014. “Although they provide limited information, the billing records allow us to study a very large number of children without having to separately collect the data,” Dr. Beukelman explained. “For example, the CARRA Registry has been very successful in enrolling over 2,000 children with JIA since its start in 2015. But the billing records allowed us to include over 27,000 children with JIA in this current study.”
He continued, “Billing records give us information about doctor diagnoses that patients receive, such as JIA or cancer. They also give us information about what drugs patients receive, such TNF inhibitors or cancer drugs. When analyzed carefully, the data give us a very accurate account of what drugs patients received for the treatment of arthritis and whether or not they later developed cancer.”
What the study found was the cancer risk for JIA patients taking TNF inhibitors was similar to the risk for JIA patients who did not take TNF inhibitors.
Through his work, Dr. Beukelman hopes to reduce health provider, parent, and patient concerns about increased cancer risks due to using TNF inhibitors. This is important because TNF inhibitors can greatly improve the lives of JIA patients. However, because of the rarity of childhood cancer in the general population, he feels this study does not provide the final answer. He said that we need to continue to look at the potential long-term TNF inhibitor use.
Dr. Beukelman is an Associate Professor of Pediatrics in the Division of Rheumatology at the University of Alabama at Birmingham.