Cancers and deaths in patients with severe psoriatic arthritis on TNF-inhibitor treatment.

What is it about?

Long-term safety of tumour necrosis factor inhibitors (TNFi) has mainly been explored in patients with rheumatoid arthritis, and the data available on patients with psoriatic arthritis is limited. The aims of this study were to compare rates of cancer as well as all-cause and cause-specific mortality rates among a cohort of patients with severe psoriatic arthritis receiving TNFi with those of the general population. The British Society for Rheumatology Biologics Register (BSRBR) collects data on patients starting TNFi therapy. Between 2002 and 2006, 709 patients with psoriatic arthritis started a TNFi consented to participate in the study. Thirty-four cancers in 32 patients were reported, of which 15 were non-melanoma skin cancer. There was no increased risk of overall malignancy observed in this cohort compared with the general population. However, patients had double the risk of non-melanoma skin cancer compared with the general population. There were 41 reported deaths in the cohort; all-cause mortality significantly higher in the psoriatic arthritis patients compared with the general population, with men having a 75% increased mortality rate. Rates of death from coronary heart disease were over double that expected from the general population.

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Why is it important?

This study found reassuringly similar rates for malignancy in our population of severe psoriatic arthritis patients compared with the general population adding to data that TNFi are safe treatments in this regard in patients with psoriatic arthritis. All-cause mortality in the cohort was increased, most notably mortality from coronary heart disease, supporting the need for increased awareness of management of cardiovascular risk factors in psoriatic arthritis patients.

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