TNF-&amp;alpha; inhibitors: are they carcinogenic?

Raval, Girindra; Mehta, Paulette

doi:10.2147/dhps.s7829

Cited by 8 publications

(4 citation statements)

References 52 publications

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“…Tumor necrosis factor (TNF) inhibitors are commonly utilized medications for the treatment of immune mediated conditions including ankylosing spondylitis, inflammatory bowel disease (IBD), psoriasis and rheumatoid arthritis (RA) (1, 2). Chimeric, partly humanized, or fully human monoclonal antibodies or antibody fragments have been compared with placebo in randomized controlled trials and have demonstrated efficacy for the management of IBD (3), psoriasis (4) and RA (5).…”

Section: Introductionmentioning

confidence: 99%

Risk of Cancer Recurrence Among Individuals Exposed to Antitumor Necrosis Factor Therapy

Micic

Komaki

Alavanja

et al. 2019

Journal of Clinical Gastroenterology

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Section: Introductionmentioning

confidence: 99%

Risk of Cancer Recurrence Among Individuals Exposed to Antitumor Necrosis Factor Therapy

Micic

Komaki

Alavanja

et al. 2019

Journal of Clinical Gastroenterology

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“…TNF-α is a cytokine with pleiotropic activity, and plays a crucial role in inflammation, exhibiting pro-inflammatory characteristics and influencing various aspects of inflammation and immune regulation. Concerns have arisen about the potential induction of immunotolerance by anti-TNF treatment, leading to the development of malignancies [ 128 ]. However, we found a low risk of cancer with these agents, higher in RA patients with other comorbidities such as advanced age, exposure to other immunosuppressants, and/or hematological disorders [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Biologics Versus JAK Inhibitors. Part I: Cancer Risk. A Narrative Review

Mansilla-Polo,

Morgado-Carrasco

2024

Dermatol Ther (Heidelb)

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Introduction Biological drugs (BD) and Janus kinase inhibitors (JAKi) have revolutionized the treatment of diverse dermatoses. However, there are concerns regarding their safety, especially the risk of cancer and opportunistic infections. Here, we discuss the risk of cancer associated with the BD and JAKi used in dermatology. Methods A narrative review was carried out. All relevant articles evaluating the risk of cancer associated with BD or JAKi and published between January 2010 and February 2024 were selected. Results Multiple large studies have evaluated the association between BD, JAKi and cancer risk. However, there is a lack of prospective, comparative studies. Overall, patients undergoing BD and JAKi present a cutaneous cancer incidence similar to that in the general population. The drugs more strongly associated with non-skin cancer risk were anti-tumor necrosis factor (anti-TNFs) agents and JAKi (especially tofacitinib and oral ruxolitinib). This risk appears to increase with age, the presence of other factors (such as chronic immunosuppression from previous drugs or other comorbidities), and specific diseases such as rheumatoid arthritis (RA) and myelodysplastic syndrome. Conversely, BD such as interleukin (IL)-17 and IL-23 inhibitors may even reduce the risk of some visceral and hematological malignancies. In patients with dermatological conditions such as psoriasis and atopic dermatitis, the risk of malignancies may be lower than in other subgroups, and probably comparable to the general population. Conclusions The incidence of cancer in patients undergoing BD or JAKi is generally low. This incidence can be higher in elderly patients with RA or myelodysplastic syndrome, and in those undergoing prolonged therapy with tofacitinib or ruxolitinib (oral), or anti-TNF agents.

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“…In fact, being a double sword tool, TNF-α may play a defensive role by stimulating NK and cytotoxic T lymphocytes, but can also be “offensive” acting as mediator of cancer development through chronic inflammation promotion [ 13 ]. Thus, in theory, TNF-α antagonists may either promote or inhibit cancer growth [ 32 ]. The onset of B-cell lineage lymphomas and hepatosplenic T cell lymphoma (HSTCL) has been observed in patients with Crohn’s disease who received anti-TNF-α agents mainly in association to thiopurines [ 33 – 35 ].…”

Section: Discussionmentioning

confidence: 99%

TCD4pos lymphocytosis in rheumatoid and psoriatic arthritis patients following TNFα blocking agents

Diamanti

Laganà

Cox³

et al. 2017

J Transl Med

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BackgroundLymphocyte expansion and true lymphocytosis are commonly observed in the everyday clinical practice. The meaning of such phenomenon is often poorly understood so that discrimination between benign and malignant lymphocytosis remains difficult to establish. This is mainly true when lymphocytosis rises in patients affected by immune-mediated chronic inflammatory diseases under immunosuppressive treatment, conditions potentially associated with lymphomagenesis. In this brief report the development of mild T CD4pos lymphocytosis in a group of patients with chronic arthritis under anti-TNF-α treatment is described.MethodsTwo hundred eight rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients have been evaluated longitudinally for at least 1-year before and 2-years after anti-TNF-α therapy introduction for the possible appearance of a lymphocyte expansion. In patients who developed lymphocyte expansion, T, B and NK cells were analysed.ResultsTwenty-five out of 208 (12%) subjects developed a mild T CD4pos lymphocytosis, during anti-TNF-α therapy, which reverted after its interruption. Higher lymphocyte count, more frequent use of steroids and shorter disease duration, before biological therapy start, have emerged as risk factors for lymphocytosis development.ConclusionsThis is the first longitudinal cohort study evaluating the onset of lymphocytosis in RA and PsA patients under anti-TNF-α treatment and its possible clinical relevance. A mild T CD4pos lymphocytosis has been observed in 12% of RA and PsA patients probably related to anti-TNF-α treatment as previously reported by anecdotal cases. Patients with higher baseline lymphocyte count, use of steroids and shorter disease duration before the introduction of biologic therapy, seem to be prone to develop this laboratory reversible abnormality.

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TNF-α inhibitors: are they carcinogenic?

Cited by 8 publications

References 52 publications

Risk of Cancer Recurrence Among Individuals Exposed to Antitumor Necrosis Factor Therapy

Risk of Cancer Recurrence Among Individuals Exposed to Antitumor Necrosis Factor Therapy

Biologics Versus JAK Inhibitors. Part I: Cancer Risk. A Narrative Review

TCD4pos lymphocytosis in rheumatoid and psoriatic arthritis patients following TNFα blocking agents

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