To synthesize current evidence on tumor safety across major biologic classes and Janus kinase inhibitors in patients with immune-mediated inflammatory arthritides (IMIA), emphasizing its importance in therapeutic decision-making.
Key Findings:
Most biologic therapies show a reassuring safety profile regarding overall malignancy, necessitating individualized treatment strategies.
Non-melanoma skin cancer is the most consistent treatment-associated risk, particularly with TNF inhibitors and possibly abatacept.
Rituximab has a favorable safety profile in patients with prior lymphoproliferative disease.
IL-6 and IL-17/23 inhibitors appear largely neutral in terms of malignancy risk.
JAK inhibitors require caution in older patients, smokers, and those with a history of malignancy, highlighting the need for personalized approaches.
Interpretation:
Malignancy safety in IMIA should be assessed through an individualized framework that considers both inflammatory control and oncologic vulnerability.
Limitations:
The review focuses on data available until early 2026 and may not encompass all emerging evidence, which could impact treatment decisions.
Individual patient factors and previous cancer history significantly influence treatment decisions.
Conclusion:
The findings highlight the need for personalized treatment strategies in IMIA patients, balancing the risks of malignancy with the benefits of inflammation control, and emphasizing the importance of individualized approaches.
