Malignancies in JIA not Linked to TNFi Treatment

UAB research shows no “marked incremental increase in incident malignancies” after treatment with TNFi therapy as compared to malignancy rates associated with juvenile idiopathic arthritis (JIA).

“Receipt of non-MTX, non-TNFi systemic immunosuppressive therapies, a likely indication of severe or uncontrolled JIA, was strongly associated with an increased rate of malignancy,” writes Timothy Beukelman, of the University of Alabama, who presented his findings on Nov. 15 at Birmingham, at the American College of Rheumatology annual meeting in Washington, D.C.

Researchers used national claims data from Medicaid (2000-2010) and MarketScan (2010-2014) to evaluate malignancy rates in JIA patients. Using diagnosis codes and medication prescriptions, they identified both a JIA cohort with 27,621 children, and a comparison attention-deficit hyperactivity disorder (ADHD) cohort with 2,657,899 children. Subjects in the JIA cohort were exposed to methotrexate or leflunomide (MTX), TNFi and other systemic immunosuppressant agents which may include non-TNFI biologics or other types of non-biologics like cyclosporine.

Researchers identified incident cancers through diagnosis and treatment codes, using codes for surgery, radiation or chemotherapy. They calculated anticipated cancer rates by age, gender and race for each group, using SEER cancer surveillance data. Then they compared the SEER estimates to the standardized incidence ratios (SIR) for the study participants. They found 841 malignancies in the ADHD group (SIR 1.18), and 23 in the JIA group (SIR 2.7). Researchers noted significantly increased SIRs for all JIA patients, including those who did not receive any of the named medications (SIR 2.4). Of those who received TNFi, they found eight malignancies in 15,269 person-years of observation (SIR 3.3), an SIR number that they said was comparable to those with no TNFi exposure. They found seven malignancy cases for patients taking any type of systemic immunosuppression, noting a highly elevated SIR of 14. While two of these children had taken anakinra, the other five children had exposure to tocilizumab, rituximab, abatacept, cyclosporine, or tacrolimus.

The authors concluded that there was no association between incident malignancies after TNFi treatment, versus overall malignancy rates for all children with JIA diagnoses, based on their study. They did see an association between increased malignancies and those children taking systemic immunosuppressive therapies that weren’t MTX or TNFi, which authors said could indicate severe or uncontrolled JIA.

Disclosures:

Dr. Beukelman and the study co-authors have ties with Novartis, UCB, Amgen, Lilly, Merck, Roche/Genentech, Janssen, Corrona, Pfizer, BMS, Crescendo and AbbVie. 

References:

Timothy Beukelman. "Tumor Necrosis Factor Inhibitors and the Risk of Malignancy in the Treatment of Juvenile Idiopathic Arthritis," Abstract number 2982. 11 a.m., Nov. 15, 2016. ACR/ARHP 2016 Annual Meeting.