Risk of solid cancers overall and by subtypes in patients with psoriatic arthritis treated with TNF inhibitors - a Nordic cohort study

Karin Hellgren, Christine Ballegaard, Bénédicte Delcoigne, René Cordtz, Dan Nordström, Kalle Aaltonen, Björn Guðbjörnsson, Þorvarður Jón Löve, Sella Aarrestad Provan, Joe Sexton, Kristian Zobbe, Lars Erik Kristensen, Johan Askling, Lene Dreyer

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


OBJECTIVES: To investigate whether TNF inhibitors (TNFi) are associated with increased risk of solid cancer in patients with psoriatic arthritis (PsA). METHODS: From the Nordic clinical rheumatology registers (CRR) here: SRQ/ARTIS (Sweden), DANBIO (Denmark), NOR-DMARD (Norway), ROB-FIN (Finland) and ICEBIO (Iceland) we identified PsA patients who started a first TNFi 2001-2017 (n = 9655). We identified patients with PsA not treated with biologics from (i) the CRR (n = 14 809) and (ii) the national patient registers (PR, n = 31 350). By linkage to the national cancer registers, we collected information on incident solid cancer overall and for eight cancer types. We used Cox regression to estimate hazard ratio (HR) with 95% CI of cancer (per country and pooled) in TNFi-exposed vs biologics-naïve, adjusting for age, sex, calendar period, comorbidities and disease activity. We also assessed standardized incidence ratios (SIR) in TNFi-exposed PsA vs the general population (GP). RESULTS: We identified 296 solid cancers among the TNFi-exposed PsA patients (55 850 person-years); the pooled adjusted HR for solid cancer overall was 1.0 (0.9-1.2) for TNFi-exposed vs biologics-naïve PsA from the CRR, and 0.8 (0.7-1.0) vs biologics-naïve PsA from the PRs. There were no significantly increased risks for any of the cancer types under study. The pooled SIR of solid cancer overall in TNFi treated PsA vs GP was 1.0 (0.9-1.1). CONCLUSION: In this large cohort study from five Nordic countries, we found no increased risk of solid cancer in TNFi-treated PsA patients, neither for solid cancer overall nor for eight common cancer types.
Original languageEnglish
Pages (from-to)3656-3668
Number of pages13
JournalRheumatology (Oxford, England)
Issue number8
Publication statusPublished - 5 Jan 2021

Bibliographical note

© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].

Other keywords

  • Psoriatic arthritis
  • Neoplasms/epidemiology
  • Tumor necrosis factor inhibitor prediction
  • Cohort studies
  • Scandinavian and Nordic countries
  • Epidemiology
  • Humans
  • Middle Aged
  • Risk Factors
  • Proportional Hazards Models
  • Male
  • Glucocorticoids/therapeutic use
  • Arthritis, Psoriatic/drug therapy
  • Scandinavian and Nordic Countries/epidemiology
  • Tumor Necrosis Factor Inhibitors/therapeutic use
  • Adult
  • Female
  • Registries
  • Antirheumatic Agents/therapeutic use
  • Cohort Studies
  • Methotrexate/therapeutic use


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