Tumor Necrosis Factor Inhibitors and Cancer Recurrence in Patients With Rheumatoid Arthritis

Is tumor necrosis factor inhibitors (TNFi) treatment in rheumatoid arthritis (RA) really associated with an increased risk for cancer recurrence? In a study published in Annals of Internal Medicine, researchers aim to asses if there is truly a link between TNFi treatment in RA and an increased risk of cancer recurrence. 

According to the study, researchers used a population-based cohort of Swedish patients with RA. Patients included in this study had RA and started TNFi treatment between 2001 and 2015, after being diagnosed with cancer; and then matched patients with RA and a history of the same cancer who had never received biologics. 

Authors in #AnnalsofInternalMedicine find, TNF inhibitors are not associated with increased #cancer recurrence in patients with #RheumatoidArthritis and a history of cancer https://t.co/Ntgk87YS6O. pic.twitter.com/x8JuKliMNW

— Annals of Int Med (@AnnalsofIM) August 20, 2018

Are we being too cautious in our #RA patients with a Hx of #cancer? Another study showing no increased risk (although not excluding it 100%) with TNF inh.
Cancer Recurrence in TNFi-Treated RA | Ann Intern Med | ACP | https://t.co/Ulksn1povQ

— Christos Koutsianas (@Dr_C_Koutsianas) August 14, 2018

The primary outcome was the first recurrence of cancer. Various models were used to evaluate hazard ratios (HRs), taking into account time, cancer type, and whether the cancer was invasive or in situ (or tumor, node, metastasis [TNM] classification system stage in a subset of patients). 

No increased risk in cancer recurrence was seen in pts with RA treated with TNFi. 467 RA pts with ca starting TNFi vs 2164 with the same ca without TNFi. Recurrence (9% vs 7%) (HR 1.06 [0.7-1.54]). Posted by @AnnalsofIM @EMEUNET #rheumatoidarthritis https://t.co/pZjK14Auvg

— Sebastian C Rodriguez-García (@sdlcrodriguez) August 19, 2018

https://twitter.com/DrMAUrsani/status/1029834539043119112

Results showed that within the 467 patients who started TNFi treatment (mean time after cancer diagnosis, 7.9 years), 42 had cancer recurrences (9.0%; mean follow-up, 5.3 years); among 2,164 matched patients with the same cancer history, 155 had recurrences (7.2%; mean follow-up, 4.3 years) (HR, 1.06 [95% CI, 0.73 to 1.54). 

“The findings suggest that TNFi treatment is not associated with increased risk for cancer recurrence in patients with RA, although meaningful risk increases could not be ruled out completely,” the researchers concluded. 

For more about rheumatoid arthritis, check out an article on rheumatoid arthritis and the mucosal origins hypothesis.  

SOURCE: Annals of Internal Medicine