December 26, 2019
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Anti-TNF alpha not linked with recurrent, new primary cancers in IBD

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Patients with inflammatory bowel disease and other immune-mediated diseases treated with anti-TNF alpha who previously had cancer are not at greater risk for recurrent or new primary cancers, according to the results of a population-based study.

“Historically, clinicians have been concerned about whether [anti-TNF alpha] therapies predispose people to cancer, resulting in a reluctance to prescribe these medications to patients with a history of cancer,” Akbar K. Waljee, MD, of the division of gastroenterology and hepatology at the University of Michigan, and colleagues wrote. “Because [anti-TNF alpha] therapy is often avoided in patients with a history of cancer, little is known about the risk of recurrent cancers in association with anti-TNF use.”

Researchers recruited adults with either IBD, rheumatoid arthritis (RA) or psoriasis and a primary cancer between 1999 and 2016 from the Danish National Patient registry and the Danish Cancer registry (n = 25,738). They matched patients 1:10 between those treated with anti-TNF and those who were not. They excluded patients who were diagnosed with cancer before their first anti-TNF treatment, individuals diagnosed with IBD, RA or psoriasis after anti-TNF alpha initiation, as well as patients who had less than five matched controls.

Investigators estimated the development of recurrent or new primary cancer in patients who received anti-TNF (n = 434) compared with patients who did not (n = 4,328).

During 18,752 person-years of follow-up, Waljee and colleagues identified 635 individuals who developed recurrent or new primary cancer, including 72 who received anti-TNF and 563 who did not.

The incidence of recurrent or new primary cancer was 30.3 cases per 1,000 person-years among the anti-TNF group (95% CI, 24–38.2) compared with 34.4 cases per 1,000 person-years in the control group (31.7–37.3; adjusted HR = 0.82; 95 % CI, 0.61–1.11). In the group treated with anti-TNF, the median time between treatment initiation and recurrent or new primary cancer was 2.8 years (interquartile range = 1.7–5.4 years).

Waljee and colleagues wrote that their findings show that anti-TNF alpha therapy did not lead to increased risk for recurrent or new primary cancers in patients with IBD, RA or psoriasis and a history of cancer.

“Our real-life observational study provides the scale and duration of follow-up needed to address the safety of anti-TNF therapy in people with a history of cancer,” they wrote. “These observations might guide clinical decision-making among providers treating immune-mediated diseases with anti-TNF alpha medications.” – by Alex Young

Disclosure: The authors report no relevant financial disclosures.