PROLONGED exposure to targeted therapies has not been linked to an elevated risk of cancer in spondyloarthritis (SpA), according to a nationwide French cohort of more than 56,000 patients, with longer annual exposure instead associated with a modestly lower incidence.
The study drew on the French national health insurance database to identify adults with SpA, including psoriatic arthritis, axial SpA and other subtypes, who initiated a targeted therapy between January 2014 and September 2022. Eligible drug classes were TNF inhibitors, IL-17 inhibitors, IL-12/23 inhibitors, IL-23 inhibitors, and JAK inhibitors. Patients with prior cancer, HIV infection, or organ transplantation were excluded.
Follow-up began after a three-month lag and continued to December 2024. Exposure was assessed annually and classified as six months or less, or more than six months, per year. Incident cancer was the primary outcome.
The cohort comprised 56,591 patients, 53.9% women, with a mean age of 44 years (SD 13) and a median follow-up of 5.0 years. A total of 1,224 cancers occurred during follow-up: 1,029 solid, 116 haematological and 79 unclassified. Exposure of more than six months per year, compared with six months or less, was associated with a lower risk of overall cancer (weighted HR 0.86, 95% CI 0.75 to 0.99). The association held for haematological malignancies (wHR 0.65, 95% CI 0.42 to 0.99) but not for solid cancers (wHR 0.92, 95% CI 0.79 to 1.07). Cumulative exposure history across multiple years showed no association with cancer risk.
The findings offer reassurance for clinicians counselling patients on extended targeted therapy, indicating that sustained treatment has not carried a measurable malignancy penalty in this population. The lower haematological signal warrants cautious interpretation given the observational design, the small number of events and the possibility that patients remaining on therapy longer differ systematically from those who stop. Confounding by indication and by disease activity cannot be excluded. Further work separating individual drug classes would help refine how the risk of cancer in spondyloarthritis is discussed at the bedside.
Reference
Tankovic K et al. Risk of cancer according to duration of targeted therapy exposure in spondyloarthritis: a nationwide cohort study from the French health insurance database. Arthritis Rheumatol. 2026;DOI:10.1002/art.70297
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