Long-Term Use of bDMARDs Not Linked to Increased Cancer Risk in Patients with r-axSpA
A large population-based cohort study published in JCR: Journal of Clinical Rheumatology, offers reassuring news for clinicians managing radiographic axial spondyloarthritis (r-axSpA) with biologic agents. Researchers found no significant association between tumor necrosis factor inhibitors (TNFis) or interleukin-17 inhibitors (IL-17is) and an increased risk of cancer.
Analyzing data from 41,889 Korean patients diagnosed with r-axSpA between 2010 and 2021, investigators assessed cancer incidence rates among those exposed to TNFis or IL-17is compared with those who had not received biologic disease-modifying antirheumatic drugs (bDMARDs). The study reported incidence rates of 53.8, 37.6, and 67.3 per 10,000 person-years for bDMARDs nonexposure, TNFi exposure, and IL-17 exposure, respectively.
Crucially, TNFi exposure did not increase the risk of overall cancers compared to bDMARDs nonexposure (adjusted hazard ratio [aHR] = 0.9; 95% CI = 0.8–1.1). Similarly, IL-17i exposure was not associated with higher cancer risk either against bDMARDs nonexposure (aHR = 1.2; 95% CI = 0.5–3.0) or TNFi exposure (aHR = 1.3; 95% CI = 0.6–3.3). Researchers also noted no significant associations between biologic exposures and specific cancer subtypes.
"In patients with r-axSpA, there was no evidence of increased cancer risk with TNFis and IL-17is exposures compared with bDMARDs nonexposure," the authors concluded. They emphasized that "the use of bDMARDs is safe with respect to cancer risk in patients with r-axSpA."
For practicing rheumatologists, these findings support the continued use of TNFis and IL-17is without heightened concern for malignancy, a critical reassurance for long-term management strategies.
Reference
Kwon OC, Lee HS, Yang J, Park MC. Risk of cancers according to the use of biological agents in patients with radiographic axial spondyloarthritis: a nationwide population-based cohort study. J Clin Rheumatol. 2025;31(3):e13-e21. doi:10.1097/RHU.0000000000002188
