A study assessed the risk of cancer in patients receiving long-term treatment with tumor necrosis factor (TNF)-alpha inhibitors and found that cumulative use for two years increased the risk for lymphoma and leukemia but not other cancers.

The study was led by Jihun Song, of the Seoul National University Graduate School in South Korea, and published in Scientific Reports.

The retrospective cohort study included 7,645 Korean patients with psoriasis (15.9%) or rheumatoid arthritis (RA; 90.7%) who were receiving etanercept, infliximab, adalimumab, or golimumab. Patients newly diagnosed with psoriasis or RA between January 1, 2010, and December 31, 2018, were identified from a national claims database.

The average cumulative use of TNF inhibitors during the two years of assessment was 20.2 times. The researchers compared the cancer risk in these individuals versus a cohort with these conditions that did not use TNF inhibitors.

Increased risk of cancer?

Overall, use of TNF inhibitors did not appear to increase the incidence of cancer. Specifically, the researchers did not observe an increased risk for colorectal, liver, lung, kidney, breast, or thyroid cancer in those receiving TNF inhibitors. However, there was an increased risk of lymphoma in infliximab-treated patients (adjusted hazard ratio [aHR], 2.49; P<.01), which was “statistically significant.” There was also an increased risk of leukemia in patients treated with etanercept (aHR, 3.87; P<.01) and adalimumab (aHR, 3.36; P<.001). Overall, the risk of lymphoma and leukemia was 1.50 and 2.08, respectively, times higher in the TNF group compared with those who did not receive these medications.

The authors reported several limitations of the study, including the lack of information on dose-response relationships and therapy windows for each episode of biologic use.

“Since the use of TNF [inhibitors] increases the risk of leukemia and lymphoma, a decision for frequent prescription of TNF-[alpha] inhibitors should be more careful,” the researchers concluded.

Reference

Song J, Kim SR, Kim YJ, et al. Risk of hematologic malignancies in psoriasis and rheumatoid arthritis patients using long term TNF-α inhibitors: a retrospective nationwide study. Scientific Reports. 2025;15:7949. doi:10.1038/s41598-025-90996-z