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TNFi use not linked with increased malignancy risk in patients with JIA

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WASHINGTON — There was no increase in malignancy rate among patients with juvenile idiopathic arthritis after treatment with tumor necrosis factor inhibitors, according to findings presented at the American College of Rheumatology Annual Meeting.

“This study confirms that children diagnosed with [juvenile idiopathic arthritis] JIA have an increased risk of malignancy irrespective of treatment,” Timothy Beukelman, MD, MSCE, in the Division of Pediatric Rheumatology at the University of Alabama at Birmingham, said during his presentation. “And our study also suggests that [tumor necrosis factor] TNF inhibitors [TNFis] are not associated with a significantly increased risk of malignancy.”

Timothy Beukelman

Using United States Medicaid claims between 2000 and 2010 and U.S. MarketScan claims from 2010 to 2014, Beukelman and colleagues identified a non-JIA comparator cohort of 2,657,899 children with attention-deficit hyperactivity disorder and a cohort of 27,621 children diagnosed with JIA. Researchers excluded children with any diagnosis code for malignancy prior to the start of follow-up. The baseline assessment period was at least 6 months. Medications included methotrexate, leflunomide, TNFi and non-TNFi biologics or other non-biologics. The researchers used cancer surveillance data to calculate cancer rates by age, sex and race. They also calculated standardized incident ratios (SIRs) for observed cancer outcomes.

Researchers observed 23 incident malignancies in the JIA cohort and 841 in the ADHD cohort. The ADHD comparator had an SIR of 1.18, indicating the algorithm was specific and sensitive to cancer, according to the researchers. SIRs were significantly increased among all patients with JIA (SIR of 2.7) and among those who did not receive any medications pertaining to the study (SIR of 2.4). After 15,269 person-years of observation in children who received TNFi, there were eight observed malignancies and a corresponding SIR of 3.3, which was similar to that for children who did not receive TNFis. Based on seven cases, researchers found the SIR associated with use of other immunosuppression was elevated (SIR of 14). These other immunosuppression medications included abatacept, cyclosporine, rituximab, tacrolimus, tocilizumab and anakinra. While there was no increased rate of malignancy following TNFi, the receipt of non-methotrexate, non-TNFi therapy — which likely indicates severe or uncontrolled JIA — was associated with an increased rate of malignancy. – by Will Offit

Reference:

Beukelman T, et al. Abstract #2982. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.

Disclosures: Beukelman reports funds from Novartis and UCB. Please see the full abstract for a list of all other relevant financial disclosures.