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Link Between Cancer Risk, TNF Inhibitor Use 'Cannot be Ruled Out'
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Although findings suggest that TNF inhibitors are not associated with an increased risk for cancer recurrence in patients with rheumatoid arthritis, meaningful increases in risk could not be completely ruled out, according to researchers published in the Annals of Internal Medicine.
“Recommendations have cautioned against use of TNF [inhibitors] in patients with a history of cancer, which is problematic from a clinical point of view,” Pauline Raaschou, MD, PhD, of the Karolinska Institute, and colleagues wrote. “The cumulative probability of any cancer diagnosis is 15% at age 65 years and 30% at age 75 years. For many patients with RA or other chronic inflammatory diseases, our lack of evidence may negatively affect chances of optimal disease control or risk for cancer recurrence.”
To determine whether TNF inhibitor therapy for RA was associated with an increased risk for cancer recurrence, the researchers conducted a population-based cohort study linking data from multiple registers. These included the Swedish National Patient Register, the Swedish Prescribed Drug Register, the Swedish Cancer Registry, the Swedish Population Register, the National Register of Education, and the Swedish Cause of Death Register.
After identifying 72,377 individuals in the Swedish National Patient register living with RA in 2001, or were subsequently diagnosed, Raaschou and colleagues grouped together 467 who began treatment with TNF inhibitors between 2001 and 2015 and had a history of cancer recorded in the Swedish Cancer Registry in 1960 or later. These patients were then matched to 2,164 patients with RA and a history of the same cancer but had never received biologics. The primary outcome was the first recurrence of cancer.
According to the researchers, of the 467 patients with RA who initiated TNF-inhibitor treatment, 42, or 9%, experienced cancer recurrences. Among the matched patients who never received biologics, 7.2% had recurring cancer (HR = 1.06; 95% CI, 0.73-1.54). The researchers noted that hazard ratios were close to 1 in analyses of patient subsets matched based on cancer stage, or with similar time from cancer diagnosis to the initiation of TNF inhibitor therapy. Further, several confidence intervals included upper limits that were close to 2, they said.
“Our findings suggest that TNF [inhibitor] treatment was not associated with an increased risk for cancer recurrence in patients with RA and a history of cancer compared with those who had a similar cancer history and were selected to receive other RA treatments,” Raaschou and colleagues wrote. “However, as suggested by the upper limit of the CI for several risk estimates, a clinically meaningful risk cannot be completely ruled out. Our results should be interpreted in light of the treatment channeling that is part of clinical practice and may not be directly applicable to patients with ongoing cancer or a recent cancer diagnosis or to all cancer types.” – by Jason Laday
Disclosure: Raaschou reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Raaschou P, et al. Ann Intern Med. 2018;doi:10.7326/M17-2812.
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