Drugs that block tumor necrosis factor (TNF) increase the risk of lymphomas and other cancers in pediatric patients receiving the drugs for inflammatory conditions such as juvenile rheumatoid arthritis or Crohn disease, according to an analysis by the US Food and Drug Administration (FDA).
The FDA has identified 48 cases of malignancies, including 11 resulting in death, in pediatric patients taking infliximab, etanercept, or adalimumab, usually in combination with other immunosuppressive therapies. The TNF blockers certolizumab and golimumab, approved more recently than the other 3 drugs, were not included in the analysis because they were not widely used during the period reviewed, the agency said. Almost half the cases involved lymphomas; leukemia, melanoma, and solid organ cancers were also seen. The FDA is requiring all drugs in this class to carry a boxed warning that they pose an increased risk of cancer in children.