The enigmatic duality of high-density lipoprotein—cardioprotective yet potentially atherogenic: Comment on the article by McMahon et al

✍ Scribed by Melvin Khee-Shing Leow

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 40 KB
• Volume: 56
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.22395

✦ Synopsis

We agree with Dr. McGrath that the effect of TNF␣ antagonists on metastases or recurrences in cancer survivors remains unknown. Our study excluded all patients with any diagnosis of cancer prior to exposure with either synthetic or biologic disease-modifying antirheumatic drugs. Thus, we cannot comment on the risk of recurrent cancer. It is possible that our exclusion was incomplete because of our limited long-term historical data (left-censoring), preventing knowledge of a patient's remote history of cancer. While we might anticipate that few patients and doctors would opt for a TNF␣ antagonist if there is a known history of cancer, in fact we do not know how physicians are handling this therapeutic dilemma.

We believe that it is good medical care for all patients to have age-appropriate cancer screening. Dr. McGrath's suggestion to screen with a prostate-specific antigen, colonoscopy, and mammography in patients over 40 years of age who are receiving these drugs is an interesting hypothesis worthy of testing.