Abstract Perspective: Effect of janus kinase inhibitors and methotrexate combination on malignancy in patients with rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials


  1. The malignancy outcome among patients with rheumatoid arthritis (RA) remains uncertain. It is also unclear whether these outcomes will be affected by various treatments. With widespread use of disease-modifying antirheumatic drugs (DMARDs)  in patients with RA, especially combination conventional DMARDs and biologic DMARDs, the effect of combination therapy on malignancy needs to be addressed.
  2. Our results suggested no significant differences between Janus kinase inhibitors (JAKi) and methotrexate (MTX) combination versus MTX alone in all malignancies, non-melanomatous skin cancers (NMSC) and malignancies excluding NMSC. The overall side effect, including serious adverse events and deaths, was similar in the JAKi and MTX combination compared to MTX alone.
  3. There was no association between dose and malignancy rates in combination therapy groups versus MTX alone.
  4. We believe that our study well summarizes current available data and provides valuable information for physicians and patients regarding this pivotal topic.
  5. However, more data is needed from long-term studies, as there still exist latency periods from initiation of combination therapy to the onset of malignancy.

– Dr. Ni, study author