Cancer Risk Lower with TNF inhibitors in Rheumatoid Arthritis Save

Since the introduction of TNF inhibitors nearly 20 years ago, concerns over a potential associated cancer risk have abounded. The recent ACR RA treatment guidelines have addressed this recently, stating that patients with any solid tumor cancer or risk thereof should be treated as if they had no such solid tumor. Meaning that biologics clearly do not affect solid cancer outcomes.

The issue with remaning cancers (lymphoproliferative, skin, etc.) is still a concern to many, even though it has been well shown that the increased risks associated with TNF inhibitors also are the same risks (and same magnitude) associated with RA - especially severe RA.

Researchers from Taiwan set out to compare the relative risk of cancer in RA patients comparing those receiving TNFα antagonists and those taking nonbiologic disease-modifying anti-rheumatic drugs (nbDMARDs).

Analysis of Taiwan National Health Insurance Research Database compared 4426 patients on TNFi and 17704 on nbDMARDs.

The incidence rates of cancer among biologics and nbDMARDs cohorts were 5.35 (95% confidence interval (CI) 4.23 to 6.46) and 7.41 (95% CI 6.75 to 8.07) per 1000 person-years, respectively.

Using a modified Cox proportional hazards analysis, the risk of cancer was significantly reduced in those on TNFi (adjusted HR 0.63, 95% CI 0.49 to 0.80, P .001), after adjusting for age, gender, disease duration, major co-morbidities, and prior use of DMARDs and corticosteroids.

The SIR (compared to the general population for hematologic cancer) was higher in RA patients on TNFi (SIR 4.64; 95% CI 2.65, 7.53) compared to those on nbDMARDs  (SIR 2.28; 1.55, 3.24). Although an increased risk for hematologic cancers was seen in the biologics cohort, this was not statistically significant.

These investigators found that RA patients taking TNF-α antagonists had a lower risk of cancer, but not hematologic cancer, when compared to RA patients on nbDMARDs alone.