Association of biological therapy and malignancy in inflammatory rheumatic diseases

Marija Bakula, Martina Jambrović, Mislav Cerovec, Ivan Padjen, Branimir Anić

Inflammatory rheumatic diseases are chronic, progressive autoimmune diseases which affect the musculoskeletal system and other organ systems. Nowadays, a large number of patients is treated with biological therapy. Although biological drugs selectively affect specific molecules of the immune system, they weaken the overall immune system of the body. Therefore, the patients are more susceptible to infections and other diseases such as lymphomas, breast and skin cancers and melanomas. Chronic inflammation which occurs due to autoimmune disease is also a risk factor for malignant development. So far, studies have not proven direct correlation between biological therapy and solid or haematologic tumours. On the other hand, the increased risk for developing skin cancer in patients on tumour necrosis factor alpha inhibitors has been described. In this review paper we analysed the available medical literature on the
risks for malignant disease development in patients with rheumatic diseases who are on biological disease – modifying anti-rheumatic drugs.

Sistemske upalne reumatske bolesti jesu kronične, progresivne autoimunosne bolesti koje zahvaćaju lokomotorni sustav i druge organske sustave. Danas je sve više bolesnika liječeno biološkom terapijom. Iako biološki lijekovi selektivno djeluju na specifične molekule imunosnog sustava, oni smanjuju opću obrambenu funkciju organizma, zbog čega su bolesnici podložniji infekcijama, ali i nekim malignim bolestima poput limfoma, karcinoma kože, dojke ili melanoma. Također, sama kronična upala u sklopu autoimunosne bolesti jest rizični čimbenik za razvoj tumorske bolesti. Prema do sada objavljenim studijama, nije dokazana jednoznačna povezanost primjene bioloških lijekova s razvojem solidnih i hematoloških tumora. Suprotno tomu, istraživanja su pokazala povezanost primjene inhibitora tumorske nekroze alfa i razvoja tumora kože. U ovom preglednom radu analizirana je dostupna medicinska literatura o rizicima za razvoj malignih bolesti u bolesnika s reumatološkim bolestima koji su liječeni biološkim antireumatskim lijekovima koji mijenjaju tijek bolesti.