Clin Exp Rheumatol. 2026 Jul 9. doi: 10.55563/clinexprheumatol/msvat0. Online ahead of print.
ABSTRACT
OBJECTIVES: To assess whether the use of immunosuppressants after cancer diagnosis in patients with spondyloarthritis (SpA) and rheumatoid arthritis (RA) is associated with increased risk of cancer recurrence or mortality.
METHODS: We consecutively enrolled patients with spondyloarthritis (SpA), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) and concomitant invasive cancer (2015-2024). The association between treatment exposure and recurrence was estimated using time-dependent Cox proportional hazards models to prevent immortal time bias. Sensitivity analyses adjusted for age, comorbidities, and treatment history. The impact of treatment timing was assessed using varying thresholds (36, 48, 60, 72 months).
RESULTS: A total of 128 patients with inflammatory arthritis and invasive cancer were included (43 SpA, 35 PsA, 50 RA), with a median follow-up of 58.1 months. Twenty-four patients (18.7%) experienced cancer recurrence or progression. In time-dependent Cox proportional hazards models, post-cancer exposure to bDMARDs or JAK inhibitors was initially associated with a higher risk of recurrence (HR 2.79, 95% CI 1.33-5.84); however, this association was attenuated and no longer statistically significant after adjustment for age at cancer diagnosis and comorbidity burden. No significant association was observed between the timing of treatment initiation after cancer diagnosis and recurrence risk when different cut-offs (36, 48, 60, and 72 months) were tested.
CONCLUSIONS: The risk of cancer recurrence associated with post-cancer immunosuppression appears largely driven by patients’ age and comorbidities rather than the therapy itself. We found no evidence that initiating treatment within the standard 5-year safety window increases recurrence risk, supporting tailored, multidisciplinary management over rigid time thresholds.
PMID:42446710 | DOI:10.55563/clinexprheumatol/msvat0
