Cancer risks with JAKi and biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis or psoriatic arthritis - a national real-world cohort study

Sep 24, 2026

Uploaded by Kyle

Objective assess cancer risks with Janus kinase inhibitors (JAKi) versus biological disease-modifying antirheumatic drugs (bDMARDs) in clinical practice. Methods cohort study of patients with rheumatoid arthritis or psoriatic arthritis initiating JAKi, tumour necrosis factor inhibitors (TNFi), or other (non-TNFi) bDMARDs during 2016–2020 using Swedish Rheumatology Quality Register data linked to cancer and other registers; incidence rates and hazard ratios estimated with Cox regression. Results Overall cancer risk excluding non-melanoma skin cancer was similar in RA; non-melanoma skin cancer showed higher risk, particularly after 2+ years. Conclusion short-term cancer other than non-melanoma skin cancer risk was not higher with JAKi, but evidence suggests increased non-melanoma skin cancer risk.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

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Epidemiological science

Objective

Methods

Results

Conclusion

Introduction

What is already known on this topic

What this study adds

How this study might affect research, practice or policy

Inflammatory arthritis Handling editor Josef ssmolen ► additional supplemental material is published online only. To view, please visit the journal online ([http://dx](http://dx). [doi.org/10.1136/ard-2022-](doi.org/10.1136/ard-2022-)[ ](doi.org/10.1136/ard-2022-)[223636](223636)) . 1department of medicine solna, clinical Epidemiology division, Karolinska institutet, stockholm, sweden 2Rheumatology, Karolinska University Hospital, stockholm, sweden Correspondence to dr Viking Huss, Karolinska institute department of medicine solna, stockholm 171 76, sweden; [v](viking.huss@ki.se)[iking.huss@ki.se](viking.huss@ki.se) Received 16 november 2022 accepted 21 February 2023 published online First 3 march 2023 © author(s) (or their employer(s)) 2023. Re-use permitted under cc [BY-nc. no](BY-nc. no)[ ](BY-nc. no)[commercial re-use. see rights](commercial re-use. see rights)[ ](commercial re-use. see rights)[and permissions. published](and permissions. published)[ ](and permissions. published)[by BmJ.](by BmJ.) To cite: Huss V, Bower H, Hellgren K, et al. Ann Rheum Dis 2023;82:911–919 . EpidEmiological sciEncE Cancer risks with JAKi and biological diseasemodifying antirheumatic drugs in patients with rheumatoid arthritis or psoriatic arthritis: a national real-world cohort study Viking Huss , 1,2 Hannah Bower , 1 Karin Hellgren , 1 Thomas Frisell , 1 Johan askling , 1,2 Behalf of the aRT is group AbSTRACT Objective assess cancer risks with Janus kinase inhibitors (JaKi) versus biological disease-modifying antirheumatic drugs (bdmaR ds) in clinical practice. Methods cohort study of patients with rheumatoid arthritis (Ra) or psoriatic arthritis (psa) initiating treatment with JaKi, tumour necrosis factor inhibitors (TnFi) or other (non-TnFi) bdmaR ds 2016–2020 using prospectively collected data from the swedish Rheumatology Quality Register linked to other registers including the cancer Register. We estimated incidence rates, and HRs via cox regression, for all cancers excluding non-melanoma skin cancer (nmsc), and for individual cancer types including nmsc. Results We identified 10 447 patients with Ra and 4443 patients with psa who initiated treatment with JaKi, a non-Tn Fi bdmaR d or a Tn Fi. median follow-up times in Ra were 1.95, 2.83 and 2.49 years, respectively. in Ra, based on 38 incident cancers other than nmsc with JaKi vs 213 with Tn Fi the overall HR was 0.94 (95% ci 0.65 to 1. 38) . Based on 59 vs 189 incident nmsc, the HR was 1.39 (95% ci 1.01 to 1.91) . at 2 or more years since treatment start, the HR for nmsc was 2.12 (95% ci 1.15 to 3 .89) . in psa, based on 5 vs 73 incident cancers other than nmsc, and 8 vs 73 incident nmsc, the corresponding HRs were 1.9 (95% ci 0.7 to 5. 2) and 2.1 (95% ci 0.8 to 5. 3) . Conclusion in clinical practice, the short-term risk of cancer other than nmsc in individuals initiating treatment with JaKi is not higher than for T nFi, but we found evidence of increased risk for nmsc. INTRODUCTION Patients with rheumatoid arthritis (RA) are at increased risk of cancer overall, mainly due to an increased occurrence of lung cancer and malignant lymphoma.1–3 Increased risks of non-melanoma skin cancer (NMSC) have been reported inpatients with RA4 and also in patients with psoriatic arthritis (PsA).5 Studies on cancer risks with biological disease-modifying antirheumatic drugs (bDMARDs) such as tumour necrosis factor inhibitors (TNFi) and other (non-TNFi) bDMARDshave overall been reassuring6–11 but also pointed to signals of potential risk increases, with individual drugs and for individual cancer sites,12 for example, NMSC.8 9 13 | WHAT IS ALREADY KNOWN ON THIS TOPIC | | --- | | ⇒ Some meta-analyses of trial data and data from the ORAL Surveillance safety phase 3b–4 trial have indicated an elevated risk for nonmelanoma skin cancer, and of other types of cancer overall, in patients with rheumatoid arthritis (RA) treated with the Janus kinase inhibitor (JAKi

FAQs

What was the study objective regarding cancer risks?

To assess cancer risks with JAK inhibitors versus biological disease-modifying antirheumatic drugs in clinical practice.

How were patients and treatments selected in the study?

Patients with rheumatoid arthritis or psoriatic arthritis initiating JAKi, TNFi, or other non-TNFi bDMARDs from 2016–2020 were identified using a Swedish rheumatology registry linked to other registers, including the cancer register.

What did the study find about cancers other than non-melanoma skin cancer?

In rheumatoid arthritis, the overall short-term risk of cancer excluding non-melanoma skin cancer was not higher with JAKi compared with TNFi (overall HR 0.94, 95% CI 0.65 to 1.38).

What did the study find specifically for non-melanoma skin cancer?

The study found evidence of increased non-melanoma skin cancer risk with JAKi, with higher hazard ratios, particularly after 2 or more years since treatment start.

Sep 24, 2026

Uploaded by Kyle