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While the risk of neoplasia with tumour necrosis factor inhibitor (TNFi) use has been largely nullified in most inflammatory disorders, this risk in children is less certain. However a recent study shows no risk of increased cancer in children treated with TNFi for juvenile idiopathic arthritis (JIA), pediatric inflammatory bowel disease (pIBD) and pediatric plaque psoriasis (pPsO).
A retrospective US of administrative claims data from 2000 to 2014 compared 15,598 children on TNFi and 73,839 children not exposed to TNFi who had JIA, pIBD or pPsO.
A totl of 15 malignancies were seen with TNFi use (SIR 2.9 ; 95%CI 1.6 to 4.9) compared with 42 without TNFi exposure (SIR 2.1; 1.5 to 2.9). The adjusted Hazard Ration was 1.58 (0.88 to 2.85) for TNFi use versus no TNFi use.
Only in pIBD did the combined use of TNFi with a thiopurine result in a higher SIR (6.0 (1.2 to 17.5)) compared with TNFi use without thiopurine use (2.5 (0.7 to 6.4)).