Encouraging News for Patients on TNF Inhibitors

Jonathan Kay, MD


June 08, 2016

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Hello. I'm Dr Jonathan Kay, professor of medicine and director of clinical research in the Division of Rheumatology at UMass Memorial Medical Center and the University of Massachusetts Medical School, both in Worcester, Massachusetts. Welcome to my Medscape blog.

Previously I've talked about the incidence of malignancy in patients taking tumor necrosis factor (TNF) inhibitors for the treatment of rheumatoid arthritis. Just recently there was a paper published in Annals of the Rheumatic Diseases by Karin Hellgren, Johan Askling, and others[1] from the ARTIS Registry in Sweden and the DANBIO registry in Denmark, looking at the incidence of malignancy among patients with spondyloarthritis treated with TNF inhibitors. They assembled a cohort of nearly 9000 patients in Sweden and Denmark with spondyloarthritis initiated on TNF inhibitor therapy. They compared these with a TNF inhibitor–naive population of over 28,000 patients with spondyloarthritis, who were then compared with over 130,000 patients in the general population in Scandinavia from the national registry for malignancy. Perhaps not surprisingly, they found that there was no increased risk for any of the malignancies examined in patients with spondyloarthritis treated with TNF inhibitors, compared with those not on TNF inhibitor therapy. There was no increased risk for lung cancer, breast cancer, colon cancer, lymphoma, or even malignant melanoma.

This is an important study. It's probably the best study that could be done to look at this topic, since in Scandinavia patients are cross-referenced between the rheumatology registries, the biologic registries, and the cancer registry, allowing for these diagnoses to be tracked across the registries. We couldn't do this kind of study in the United States, where there is no way of linking a cancer registry to a rheumatologic disease registry. This publication puts to ease the concern that TNF inhibitors might increase the risk for malignancy in patients with spondyloarthritis, and shows that, as in rheumatoid arthritis, there is probably not an increased risk for malignancy with TNF inhibitor therapy.

I hope that you found this interesting, and I direct you to the paper that is now published online in Annals of the Rheumatic Diseases.[1] Thank you very much for joining me at my Medscape blog. I look forward to seeing you again.


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