No link between cancer and tumor necrosis factor inhibitor (TNFi) use in psoriatic arthritis
Study includes data from over 8,000 people with psoriatic arthritis from four Nordic countries
Madrid, Spain, 13 June 2019: The results of a study presented today at the Annual European Congress of Rheumatology (EULAR 2019) suggest that overall cancer risk is not linked to tumour necrosis factor inhibitor (TNFi) use in psoriatic arthritis.1
The study analyses the risk of primary cancer in over 8,000 TNFi-treated psoriatic arthritis patients from Sweden, Denmark, Iceland, and Finland. Results demonstrated no increase in risk of all cancer, as well as site specific cancers including colorectal, lung, malignant melanoma, pancreas, brain, female breast, endometrial, and prostate.1
“TNF inhibitors have a well-established efficacy and safety profile in patients with psoriatic arthritis and we welcome these data which contribute to our understanding in the complex area of cancer risk,” said Professor Hans Bijlsma, President, EULAR.
There was a significant increase in malignant lymphomas observed within the trial (standardised incidence ratio: 1.84, 95% confidence interval: 1.20-2.82). However, it is not clear if this is due to the psoriatic arthritis disease or the TNFi treatment. There is limited data on lymphoma risk in psoriatic arthritis, however, an excess risk has been reported for several other chronic inflammatory rheumatic diseases with a well-established doubled average risk in patients with rheumatoid arthritis.2
“Our study provides convincing evidence that the use of TNF inhibitors does not increase the risk of overall cancer in patients with psoriatic arthritis,” said Professor Lene Dreyer, Aalborg University Hospital, Aalborg, Denmark. “Further analysis is needed to assess whether the observed increase in malignant lymphomas is due to the psoriatic arthritis disease or the TNFi treatment.”
Psoriatic arthritis is a chronic inflammatory disease that affects the joints, causing pain and disability. The disease often causes swelling of the fingers and toes, mainly because of joint inflammation. Tumour necrosis factor inhibitors have been shown to be efficacious in psoriatic arthritis.3 However, tumour necrosis factor (TNF) also plays a complex role in the development and progression of cancer and so the use of TNFi may theoretically increase the risk of tumour development.4
This population-based cohort study includes 5,218, 2,039, 270 and 526 TNFi-treated psoriatic arthritis patients from ARTIS (Sweden), DANBIO (Denmark), ICEBIO (Iceland), and ROB-FIN (Finland) respectively. Patients were followed from first registration with TNFi-treatment and linked to the national cancer registry in each country (patients with a history of cancer were excluded). The cancer rates were compared with the general population standardised to age, sex and calendar period within each country. Standardised incidence ratios were estimated for both any cancer and site-specific cancers of interest.1
Abstract number: OP0005
NOTES TO EDITORS
For further information on this study, or to request an interview with the study lead, please do not hesitate to contact the EULAR Press Office:
About Rheumatic and Musculoskeletal Diseases
Rheumatic and musculoskeletal diseases (RMDs) are a diverse group of diseases that commonly affect the joints, but can also affect the muscles, other tissues and internal organs. There are more than 200 different RMDs, affecting both children and adults. They are usually caused by problems of the immune system, inflammation, infections or gradual deterioration of joints, muscle and bones. Many of these diseases are long term and worsen over time. They are typically painful and Iimit function. In severe cases, RMDs can result in significant disability, having a major impact on both quality of life and life expectancy.
The European League against Rheumatism (EULAR) is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with RMDs. EULAR aims to reduce the burden of RMDs on individuals and society and to improve the treatment, prevention and rehabilitation of RMDs. To this end, EULAR fosters excellence in education and research in the field of rheumatology. It promotes the translation of research advances into daily care and fights for the recognition of the needs of people with RMDs by the EU institutions through advocacy action.
To find out more about the activities of EULAR, visit: http://www.
1. 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. EULAR 2019; Madrid: Abstract OP0005.
2. Hellgren K, Smedby KE, Backlin C, et al. Ankylosing spondylitis, psoriatic arthritis, and risk of malignant lymphoma: a cohort study based on nationwide prospectively recorded data from Sweden. Arthritis Rheumatol. 2014 May;66(5):1282-90.
3. Ash Z, Gaujoux-Viala C, Gossec L, et al. A systematic literature review of drug therapies for the treatment of psoriatic arthritis: current evidence and meta-analysis informing the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis. 2012;71:319-26.
4. Silva-Fernández L, Lunt M, Kearsley-Fleet L, et al. The incidence of cancer in patients with rheumatoid arthritis and a prior malignancy who receive TNF inhibitors or rituximab: results from the British Society for Rheumatology Biologics Register-Rheumatoid Arthritis. Rheumatology (Oxford). 2016;55(11):2033-9. Is there an abbreviated version of the journal name available? I don’t believe so, this is how it is stated in PubMed
5. van der Heijde D, Daikh DI, Betteridge N, et al. Common language description of the term rheumatic and musculoskeletal diseases (RMDs) for use in communication with the lay public, healthcare providers and other stakeholders endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). Ann Rheum Dis. 2018 Jun;77(6):829-832.
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