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Risk of malignancy associated with paediatric use of tumour necrosis factor inhibitors

Timothy Beukelman1, Fenglong Xie2, Lang Chen2

  • 1Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Annals of the Rheumatic Diseases
|February 15, 2018
PubMed

Insights

Tumor necrosis factor inhibitor (TNFi) use in children with JIA, pIBD, and pPsO did not significantly increase malignancy risk compared to no TNFi use. Further research is needed on long-term TNFi risks in pediatric populations.

Area of Science:

  • Pediatric Rheumatology
  • Pediatric Gastroenterology
  • Pediatric Dermatology

Background:

  • Juvenile idiopathic arthritis (JIA), pediatric inflammatory bowel disease (pIBD), and pediatric plaque psoriasis (pPsO) are chronic inflammatory conditions in children.
  • Tumor necrosis factor inhibitors (TNFi) are increasingly used to manage these conditions.
  • The potential association between TNFi use and malignancy risk in pediatric patients requires thorough investigation.

Purpose of the Study:

  • To evaluate whether the use of tumor necrosis factor inhibitors (TNFi) is associated with an increased incidence of malignancy in children treated for JIA, pIBD, and pPsO.
  • To compare malignancy rates in children exposed to TNFi versus those not exposed to TNFi.

Main Methods:

  • A retrospective cohort study utilizing administrative claims data from the USA (2000-2014).
  • Exposure to TNFi was defined as permanent from the first observed use.
  • Malignancy outcomes were identified using diagnosis codes and evidence of cancer treatment.
  • Standardized incidence ratios (SIRs) and multivariable Cox proportional hazards models were used to assess malignancy risk.

Main Results:

  • The study included 15,598 children with TNFi use and 73,839 without TNFi use.
  • The standardized incidence ratio (SIR) for malignancy was 2.9 (1.6 to 4.9) in the TNFi group and 2.1 (1.5 to 2.9) in the non-TNFi group.
  • The adjusted hazard ratio (aHR) for malignancy with TNFi use was 1.58 (0.88 to 2.85), indicating no statistically significant increase in risk.
  • In pediatric IBD patients, concurrent use of TNFi and thiopurines showed a higher SIR (6.0) compared to TNFi use alone (2.5).

Conclusions:

  • Children with JIA, pIBD, and pPsO exhibit an elevated malignancy rate compared to the general population.
  • Treatment with TNFi did not appear to significantly increase the malignancy risk compared to no TNFi use in these pediatric cohorts.
  • Additional research is necessary to fully understand the long-term risks associated with TNFi therapy in children.
Abstract

Keywords:
Anti-tnfEpidemiologyJuvenile Idiopathic ArthritisTreatment

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