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TNF inhibitor use does not exacerbate malignancy risk in children with rheumatic disease
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The use of TNF inhibitors to treat juvenile idiopathic arthritis, pediatric inflammatory bowel disease and plaque psoriasis in children did not increase the risk for malignancy, according to findings published in the Annals of the Rheumatic Diseases.
However, the researchers added that children diagnosed with juvenile idiopathic arthritis, pediatric inflammatory bowel disease and plaque psoriasis did have a higher rate of malignancy compared with their healthy peers.
“There remains worry about a possible increased risk of malignancy caused by use of TNF inhibitors in children,” Timothy Beukelman, MD, MSCE, of the University of Alabama at Birmingham, told Healio Rheumatology. “This has been a difficult problem to study because childhood malignancy is very rare, and the conditions treated with TNF inhibitors are uncommon in children.”
To evaluate the association between the use of TNF inhibitors and the incidence rate of malignancy in patients being treated for juvenile idiopathic arthritis, pediatric inflammatory bowel disease and plaque psoriasis, the researchers conducted a retrospective cohort study of administrative claims data in the United States from 2000 to 2014. Included in the study were 15,598 children who had been treated with TNF inhibitors, and 73,839 who had not, representing 30,703 and 121,801 person-years of follow-up, respectively.
The researchers identified malignancy using diagnosis codes with evidence of cancer treatment. In addition, they calculated standardized incidence ratios (SIRs) that compared the observed malignancies to the expected numbers as predicted by cancer surveillance data.
According to the researchers, there were 15 malignancies among children treated with TNF inhibitors (SIR = 2.9; 95% CI, 1.6-4.9), and 42 malignancies among those who did not (SIR = 2.1; 95% CI, 1.5-2.9). The adjusted HR for malignancy associated with TNF inhibitor use was 1.58 (95% CI, 0.88-2.85).
Among patients with pediatric inflammatory bowel disease, TNF inhibitor use with thiopurine was associated with a greater SIR (6; 95% CI, 1.2-17.5) compared with TNF inhibitor use without thiopurine use (2.5; 95% CI, 0.7-6.4), the researchers wrote.
“Our study showed that use of TNF inhibitors in children with juvenile idiopathic arthritis, inflammatory bowel disease or psoriasis did not significantly increase the rate of malignancy compared to children with those conditions who did not use TNF inhibitors,” Beukelman said. “The clinical use of TNF inhibitors should likely not be restricted due to worry about an increased risk of malignancy, although more data about the long-term risks of TNF inhibitors are still needed.” – by Jason Laday
Disclosure: The researchers report funding from United States Agency for Healthcare Research and Quality. Beukelman reports receiving consulting fees from UCB, Genentech/Roche, Novartis, Bristol-Myers Squibb and Sobi. See the full study for additional researchers’ disclosures.
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