TNF inhibitors don't appear to increase malignancy risk in juvenile arthritis patients

November 13, 2016

Tumor necrosis factor inhibitors, a group of biologic drugs used to treat children with juvenile idiopathic arthritis, are not associated with a significantly increased risk of cancer, according to new research findings presented this week at the American College of Rheumatology Annual Scientific Meeting in Washington.

Juvenile idiopathic arthritis (JIA) is a systemic, chronic disease that produces joint inflammation and may also cause fevers, rashes and eye inflammation. Children and adolescents with JIA need to see a pediatric rheumatologist to treat their symptoms, control inflammation and prevent joint or organ damage.

Treatment with inhibitors (TNFi) has been linked to a possible increased risk of in other conditions, but this association is uncertain, especially in JIA. So researchers at the University of Alabama at Birmingham studied cancer rates of JIA patients who were treated with TNFi compared to with JIA who were treated differently.

"TNFi are highly effective and have greatly improved disease outcomes for most children with JIA. Nevertheless, lingering concerns about a possible increased risk of malignancy may limit the use of TNFi in clinical practice," said Timothy Beukelman, MD, MSCE, Associate Professor of Pediatrics in the Division of Rheumatology at the University of Alabama at Birmingham and a lead author of the study.

The researchers used physician diagnosis codes and medication prescriptions from U.S. Medicaid claims from 2000-2010 and U.S. MarketScan claims from 2010-2014 to identify JIA patients. They also examined children with attention-deficit hyperactivity disorder (ADHD) as a check on their ability to accurately identify cancers in the claims data. Children who had previously been diagnosed with a malignancy prior to follow-up were excluded. Use of any JIA medications ever was determined and categorized into methotrexate, TNFi, and other.

Malignancies were identified through diagnosis and treatment codes. They calculated expected cancer rates using SEER cancer surveillance data according to the age, sex and race of the patient cohorts, and calculated standardized incidence ratios (SIR) for the observed cancer outcomes compared to those SEER estimates.

The investigators identified 27,621 children with JIA. Among all children with JIA, there were 20 incident malignancies with a corresponding SIR of 2.4 [1.5-3.7]. Among children who did not receive treatment with methotrexate, TNFi or other medications, the SIR was 2.4 [1.1-4.5]. The investigators identified seven incident malignancies in 15,220 person-years of observation following any use of TNFi; the corresponding SIR was 2.9 [1.2-6.0]. The investigators reported that their approach to identifying malignancies was accurate, because the SIR for children with ADHD was 1.03 [0.96-1.11]. They also concluded that use of TNFi was not associated with a significantly increased risk of incident malignancy in children with JIA.

"These findings suggest that TNFi are not associated with a significantly increased risk of malignancy in children with JIA," said Dr. Beukelman. "Similar results have been reported in several large studies of adults with rheumatoid arthritis. Because childhood malignancy is very rare, it is difficult to attain the final, definitive answer, but I believe that the initial worries about TNFi and malignancy have been sufficiently diminished."

Explore further: First-line therapy with rituximab may lower mortality risk in RA patients with lung conditions

Related Stories

First-line therapy with rituximab may lower mortality risk in RA patients with lung conditions

November 13, 2016
Patients with rheumatoid arthritis who also have lung involvement often have increased mortality, but first-line therapy with rituximab may help them live longer when compared with the use of TNF inhibitors , according to ...

Staying on dmards through surgery does not increase post-op infection risk

November 13, 2016
Rheumatoid arthritis patients who keep using their disease-modifying antirheumatic drugs prior to surgery do not face an increased risk of infection after their procedures, according to new research findings presented this ...

TNF inhibitors may not modify polyarticular JIA disease process

June 19, 2015
(HealthDay)—For children with polyarticular juvenile idiopathic arthritis (JIA), discontinuing medications is challenging, with high relapse rates, especially after discontinuation of tumor necrosis factor inhibitor (TNFi) ...

Monocyte gene expression signatures predict how RA patients respond to anti-TNF therapy

November 13, 2016
Distinct gene expression signatures in rheumatoid arthritis patients could help rheumatologists predict how these individuals will respond to tumor necrosis factor inhibitors, and may one day enable a more personalized approach ...

ACR: TNF inhibitors linked to reduced risk of ACS in RA

October 29, 2013
(HealthDay)—For patients with rheumatoid arthritis (RA), tumor necrosis factor inhibitor (TNFi) treatment correlates with reductions in the risk of acute coronary syndromes (ACS) and myocardial infarction (MI), according ...

Cancer rate 4 times higher in children with juvenile arthritis

February 13, 2012
New research reports that incident malignancy among children with juvenile idiopathic arthritis (JIA) is four times higher than in those without the disease. Findings now available in Arthritis & Rheumatism, a journal published ...

Recommended for you

Fluid in the knee holds clues for why osteoarthritis is more common in females

June 26, 2017
Researchers have more evidence that males and females are different, this time in the fluid that helps protect the cartilage in their knee joints.

Biologics before triple therapy not cost effective for rheumatoid arthritis

May 29, 2017
Stepping up to biologic therapy when methotrexate monotherapy fails offers minimal incremental benefit over using a combination of drugs known as triple therapy, yet incurs large costs for treating rheumatoid arthritis (RA). ...

Drug for refractory psoriatic arthritis shows promise in clinical trial

May 24, 2017
In a pivotal phase-3 clinical trial led by a Stanford University School of Medicine investigator, patients with psoriatic arthritis for whom standard-of-care pharmaceutical treatments have provided no lasting relief experienced ...

Cross-species links identified for osteoarthritis

May 17, 2017
New research from the University of Liverpool, published today in the journal npj Systems Biology and Applications, has identified 'cell messages' that could help identify the early stages of osteoarthritis (OA).

Osteoarthritis could be prevented with good diet and exercise

May 12, 2017
Osteoarthritis can potentially be prevented with a good diet and regular exercise, a new expert review published in the Nature Reviews Rheumatology reports.

Rodents with trouble walking reveal potential treatment approach for most common joint disease

May 11, 2017
Maintaining the supply of a molecule that helps to nourish cartilage prevented osteoarthritis in animal models of the disease, according to a report published in Nature Communications online May 11.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.