Tumour necrosis factor inhibitors for RA do not increase risk of cancer relapse
Treatment with tumour necrosis factor inhibitor (TNFi) does not carry a heightened risk of cancer recurrence in patients with rheumatoid arthritis (RA) and a history of cancer, as shown in a recent study.
Researchers followed 467 adult RA patients who initiated TNFi treatment at a mean of 7.9 years after being diagnosed with cancer, evaluating cancer recurrence in comparison with 2,164 matched RA controls and a history of the same cancer but who had never received biologics.
Cancer recurrences occurred in 42 TNFi-treated patients during a mean follow-up of 5.3 years and in 155 biologics-naïve controls during a mean follow-up of 4.3 years (9.0 percent vs 7.2 percent). Adjusted Cox proportional hazards analysis revealed that TNFi treatment was not associated with any increase in the risk of recurrence (hazard ratio [HR], 1.06; 95 percent CI, 0.73–1.54).
However, researchers noted that several estimates from subgroup analyses had CIs with upper limits around 2 or above, suggesting that a clinically relevant risk for cancer recurrence could not be ruled out.
The study was limited by the outcome algorithm being partly nonvalidated. Also, it is possible that clinicians gave TNFi drugs only to the patients they thought had a better cancer prognosis–in other words, a low risk of relapse.
The findings should therefore be interpreted with treatment channelling in mind. Such channelling is part of clinical practice and may not be directly applicable to all cancer types or to patients with ongoing or a recent cancer diagnosis, researchers said.
Additional investigation is needed to further examine the association between TNFi treatment for RA and the risk of cancer recurrence.