Abstract
Comparison of time of onset of leukemia with patients receiving adalimumab vs other TNF α inhibitors.
Author
person
Vishal Devarkonda
Feist-Weiller Cancer Center at LSUHSC-Shreveport, Shreveport, LA
info_outline
Vishal Devarkonda, Shravya Balmuri, Shiva Jashwanth Gaddam, Dinesh Keerty, Hugo Akabane
Full text
Authors
person
Vishal Devarkonda
Feist-Weiller Cancer Center at LSUHSC-Shreveport, Shreveport, LA
info_outline
Vishal Devarkonda, Shravya Balmuri, Shiva Jashwanth Gaddam, Dinesh Keerty, Hugo Akabane
Organizations
Feist-Weiller Cancer Center at LSUHSC-Shreveport, Shreveport, LA, LSU Health Shreveport, Shreveport, LA, LSUHSC-S, Feist-Weiller Cancer Center, Shreveport, LA, Feist Weiller Cancer Cener, Shreveport, LA
Abstract Disclosures
Research Funding
No funding received
None.
Background:
TNF α (Tumor necrosis factor alpha) inhibitors were first approved by US FDA (Food and drug administration) in the late 1990s to manage several inflammatory conditions. Theoretically, TNF α inhibitors have an elevated risk of malignancies as TNF plays a role in cell apoptosis. The development of newer human monoclonal TNF α antibodies like Adalimumab has been approved for a broader clinical spectrum of activity. However, any increase relative risk of malignancies associated with these drugs is highly debatable, with many post-marketing surveillance studies showing no significant increases in the relative risk of malignancies receiving these drugs. We hypothesize with the null hypothesis stating that there is no significant difference in the time of onset of acute leukemia in the patients receiving Adalimumab in comparison with other TNF α inhibitors.
Methods:
A comprehensive literature search of PubMed, Embase, and Cochrane was conducted. A total of 19 cases of acute leukemia were reported in association with TNF α inhibitors receiving it for various inflammatory conditions. Of nineteen patients, ten received Adalimumab as the last TNF α inhibitor, while nine received other TNF α inhibitors for various inflammatory etiologies. These patients received multiple lines of treatment with steroids, Thiopurines, Methotrexate, and TNF α inhibitors with varying duration of disease activity. We performed a one-way ANOVA analysis comparing the mean duration of the last TNF inhibitor with the time to diagnosis of leukemia.
Results:
The results indicate a significant effect [F (1, 17) = 5.652, p=0.029 < 0.05]. The comparison revealed a significant difference between the patients who took Adalimumab (M=5.650; SD=3.8733) and other TNF α inhibitors (M=23.333; SD=23.2379) as the last drug. We, therefore, reject the null hypothesis as there is a significant difference in the time of onset of acute leukemia in the patients receiving Adalimumab in comparison with other TNF α inhibitors.
Conclusions:
In this limited study of the cases of acute leukemia reported in the literature receiving TNF inhibitors for various inflammatory conditions, patients receiving Adalimumab would have the early time of onset of leukemia in comparison with the other TNF α inhibitors.
Results of one way ANOVA analysis.
Sl.no
TNFαinhibitor
Number of patients diagnosed with acute leukemia
Means
Sum of Squares
df
F
Sig.
1.
Adalimumab group
10
5.65
1481.21
1
5.65
.029
2.
Rest of the TNF α inhibitors
9
23.33
4455.025
17
4 organizations
2 drugs
1 target
Organization
Feist-Weiller Cancer Center at LSUHSC-ShreveportOrganization
LSU Health ShreveportOrganization
LSUHSC-SOrganization
Feist Weiller Cancer CenerDrug
AdalimumabDrug
TNF α inhibitors