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Do TNF Inhibitors Increase Cancer Risk?

Tumor necrosis factor (TNF) inhibitors were not associated with an increased risk of malignancies, aside from lymphomas, among patients with psoriatic arthritis (PsA), according to the findings of a recent study. The findings were presented at the 2019 Annual European Congress of Rheumatology in Madrid, Spain.

“TNF inhibitors effectively reduce inflammation in PsA. However, a possible association between treatment with TNF inhibitors and an increased cancer risk has previously been suggested,” the researchers said.

The study included 5128 participants enrolled in ARTIS, 2039 participants in DANBIO, 270 participants in ICEBIO, and 526 participants in ROB-FIN, equaling a total of 44,041 patien-years of follow up. Participants were linked to the National Cancer Registry in each country. 

Risk of primary cancer among participants treated with TNF inhibitors compared with cancer rates among the general population were calculated and standardized based on age, sex, and calendar period within each country. In addition, the researchers estimated the standardized incidence ratios (SIRs) for each country and pooled SIRs for both any cancer and site-specific cancers.

For all cancers, SIRs associated with TNF inhibitors for participants in ARTIS, DANBIO, ICEBIO, and ROB-FIN were 0.94, 0.99, 1.71, and 1.28, respectively, the researchers said.

While the risk for Hodgkin and non-Hodgkin lymphoma was higher among participants treated with TNF inhibitors compared with the general population (SIR 1.84), the researchers found no increased risk for malignant melanoma, colorectal, lung, prostate, brain, corpus uteri, and female breast cancers.

“Our results suggest that the overall cancer risk for TNF inhibitor-treated PsA patients is not increased compared to the general population,” the researchers concluded. “Further analysis of the risk of malignant lymphomas will inform on whether the increased risk we observed is attributed to the PsA disease or treatment with TNF inhibitors.” 


Ballegaard C, Hellgren K, Cordtz R, et al. Incidence of overall and site-specific cancers in TNF inhibitor treated patients with psoriatic arthritis: A population-based cohort study from 4 Nordic countries. Presented at: 2019 Annual European Congress of Rheumatology; Madrid, Spain; June 12-15, 2019. Abstract OP0005.

online program

Online Program Improves Function, Mental Health in Patients With Psoriasis

A recent study found that an online health program was equivalent to in-person care at reducing functional impairment and depressive symptoms among patients with psoriasis.

In the trial, 296 participants with psoriasis were randomized to online or in-person care for 12 months. Functional impairment and depression were assessed using the five-level EuroQol 5 Dimensions (EQ-5D-5L) and Patient Health Questionnaire-9 (PHQ-9) at baseline and at 3-month intervals.

The researchers found that the between-group difference in overall improvement in EuroQol Visual Analogue Scale was -0.002, which fell within the equivalence margin of ±8. Likewise, the between-group difference in overall improvement in EQ-5D-5L index was 0, which fell within the equivalence margin of ±0.1. The between-group difference in overall improvement in PHQ-9 was 0.33, also falling within the equivalence margin of ±3.

While the researchers noted slightly different attrition rates between online and in-person arms (11% vs 9%), they said it had no impact on outcomes. 


Young PM, Chen AY, Ford AR, Cheng MY, Lane CJ, Armstrong AW. Effects of online care on functional and psychological outcomes in patients with psoriasis: A randomized controlled trial [published online June 5, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.05.089


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