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Do TNF Inhibitors Increase Cancer Risk?

Tumor necrosis factor inhibitors (TNFi) 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.

“TNFi effectively reduce inflammation in PsA. However, a possible association between treatment with TNFi 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 from Sweden, Denmark, Iceland, and Finland, respectively, equaling a total of 44,041 patient years of follow up. Participants were linked to the National Cancer Registry in each country.
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Risk of primary cancer among participants treated with TNFi compared with cancer rates among the general population cancer 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 TNFi 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 TNFi 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 TNFi-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 TNFi.”


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: EULAR 2019; Madrid, Spain; June 12-15, 2019. Abstract OP0005.


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