Melanoma and methotrexate don’t mix

Latest findings from the ARAD database on cancer risk in RA show that melanoma should be considered a contraindication for methotrexate, an expert says.

The analysis of the Australian Rheumatology Association database found an increased risk of melanoma in people with RA, regardless of whether they were taking biologics.

The findings were consistent with a previous study that reported a three fold increased risk of melanoma in Australian RA patients.

“Taken together these observations suggest that RA status, and possibly methotrexate exposure related to RA status, may be responsible for this observed increased melanoma risk,” the study authors wrote in BMC Musculoskeletal Disorders.

Speaking to the limbic lead author Rachelle Buchbinder from Monash University in Melbourne said the study results showed that it was time melanoma was considered a contraindication to the use of methotrexate.

She said the findings were particularly relevant to Australia as prescribing regulations stipulated that patients needed to try methotrexate before progressing to biologics – even if they have a history of melanoma.

Melanoma was not currently listed as a side effect on product information for methotrexate and was therefore not considered a contraindication by authorities, Dr Buchbinder explained.

“We have to make the point that even if the product information is not changed, even if it’s only pertinent to Australia, based on the best available evidence methotrexate is a contraindication to the use of methotrexate in someone with a prior history of melanoma,” she said.

The findings also illustrated the importance of screening RA patients for melanoma, particularly if they are taking methotrexate, she added.

The study of all RA patients enrolled in the Australian Rheumatology Association Database before 25 October 2010 found 44 malignancies after 5752 person-years in the TNFi-exposed group (N = 2145) and 32 malignancies were reported after 1682 person-years in the biologic-naïve group (N = 803).

No overall increased risk of malignancy in TNFi-treated RA patients was found when compared with the general population or with biologic-naïve RA patients.

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