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Psoriatic arthritis: malignancy and mortality rates with TNF-inhibitors

An analysis of data from the British Society for Rheumatology Biologics Register (BSRBR) has found no increased risk for malignancy in patients with severe psoriatic arthritis (PsA) being treated with a tumour-necrosis factor inhibitor (TNFi) compared with members of the general UK population.

The study, conducted by researchers at the University of Manchester, used data from the national cancer register and the national death register to identify cancers and deaths in patients included in the BSRBR from start of TNFi until December 31, 2012.

Among the 709 patients identified, 34 cancers and 41 deaths were observed. Standardised incidence ratios (SIRs) for overall malignancy were not increased (SIR, 0.94; 95% CI, 0.65-1.34). However, there was a significantly increased incidence of non-melanoma skin cancer (SIR, 2.12; 95% CI, 1.19-3.50).

All-cause mortality was also found to be increased in the cohort (standardised mortality ratio [SMR] 1.56; 95% CI, 1.12-2.11). There was no increase in death because of malignancy, but death because of coronary heart disease (CHD) was increased (SMR 2.42; 95% CI, 1.11-4.59). Forty-two per cent of the excess deaths were attributed to circulatory disease.

Presenting the findings in the journal Rheumatology, the authors say the similar rates of malignancy in the study cohort and the general public are reassuring and add to the evidence supporting the safety of TNFi therapy in this patient group. However, they said the increased all-cause mortality among patients with PsA, particularly from CHD, highlights the need for increased awareness of the management of cardiovascular risk factors in patients with PsA.


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