TNF Inhibitor Use in Psoriatic Arthritis Does Not Increase Solid Cancer Risk

The use of tumor necrosis factor (TNF) inhibitors in patients with psoriatic arthritis does not increase the risk of solid cancer, according to a study published in Rheumatology. 1

Several inflammatory conditions are associated with increased cancer risk, but this association is not well studied in psoriatic arthritis. While TNF inhibitor use may lead to increased cancer incidence, this has not been reported in studies evaluating TNF inhibitor treatment in psoriatic arthritis. However, reports on risks for specific cancer types are limited as are risk assessments of cancer by TNF inhibitor agent in psoriatic arthritis.

In this population-based Nordic study, Karin Hellgren, MD, PhD, of the Karolinska Institutet in Stockholm, Sweden, and colleagues evaluated the association between TNF inhibitor use, adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab, and the risk of solid cancer, both overall and for common cancer types in patients with psoriatic arthritis.

Karin Hellgren, MD, PhD

Combined nationwide clinical and health registers from Sweden, Denmark, Norway, Finland and Iceland were used to identify 9,655 patients with psoriatic arthritis who started a first TNF inhibitor between 2001 and 2017. Information on incident solid cancer overall and for eight cancer types (colorectal, pancreas, liver, lung, corpus uteri, breast, prostate, and brain) was compared with that from patients with psoriatic arthritis who were biologics naïve (clinical rheumatology registers n = 14,809, the national patient registers n = 31,350).

A total of 296 solid cancers were identified among the TNF inhibitor-exposed patients (55,850 person-years). The pooled adjusted hazard ratio for solid cancer overall was 1.0 (0.9–1.2) for TNF inhibitor-exposed patients versus biologics-naïve patients from the clinical rheumatology registers, and 0.8 (0.7–1.0) versus biologics-naïve participants from the national patient registers. There were no significantly increased risks for any of the cancer types. The incidence of solid cancer overall was largely similar across TNF inhibitor agents.

Investigators determined, “Treatment with TNF inhibitors is not associated with increased risks of solid cancer overall, or eight common cancer types. There were no indications of different crude incidence of solid cancers overall by TNF inhibitor agent.”

Similarly, the study found no increased cancer risk in TNF inhibitor-treated psoriatic arthritis versus the general population. The pooled standardized incidence ratios of solid cancer overall in TNF inhibitor treated psoriatic arthritis versus general population was 1.0 (0.9–1.1).

While consistent with results on this association from other chronic inflammatory diseases, investigators concluded, “the findings are of clinical importance for risk communication with patients with psoriatic arthritis.”

Reference:

Hellgren K, Ballegaard C, Delcoigne B, et al. Risk of solid cancers overall and by subtypes in patients with psoriatic arthritis treated with TNF inhibitors - a Nordic cohort study [published online ahead of print, 2021 Jan 5]. Rheumatology (Oxford). 2021;keaa828. doi:10.1093/rheumatology/keaa828