SynthesisPloS one2012
Cancer risk of anti-TNF-α at recommended doses in adult rheumatoid arthritis: a meta-analysis with intention to treat and per protocol analyses.
Synthesis in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 81 citations in OpenAlex.
- Tumor Necrosis Factor-Alpha Inhibitor Use and Malignancy Risk: A Systematic Review and Patient Level Meta-Analysis.Cancers · 2025Pooled it
- Risk of non-melanoma skin cancer for rheumatoid arthritis patients receiving TNF antagonist: a systematic review and meta-analysis.Clinical rheumatology · 2020Pooled it
- Malignancy risk of anti-tumor necrosis factor alpha blockers: an overview of systematic reviews and meta-analyses.Clinical rheumatology · 2016Pooled it
- Safety of TNF-α inhibitors therapy in patients with rheumatoid arthritis: an umbrella review.EClinicalMedicine · 2025Article
- Long-term risk of de novo malignancy with tumor necrosis factor alpha (TNF) inhibitor immunosuppression: a multicenter, retrospective cohort study.Journal of inflammation (London, England) · 2025Article
- Incidence of Malignancies and the Association with Biological Disease-Modifying Antirheumatic Drugs in Japanese Patients with Rheumatoid Arthritis: A Time-Dependent Analysis from the IORRA Patient Registry.Rheumatology and therapy · 2024Article
- Golimumab (anti-TNF monoclonal antibody): where we stand today.Human vaccines & immunotherapeutics · 2021Review
- Down-regulation of microRNA-142-3p inhibits the aggressive phenotypes of rheumatoid arthritis fibroblast-like synoviocytes through inhibiting nuclear factor-κB signaling.Bioscience reports · 2019Article
- TNF-α inhibitors in the treatment of hidradenitis suppurativa.Therapeutic advances in chronic disease · 2019Review
- Malignancy Risk and Recurrence with Psoriasis and its Treatments: A Concise Update.American journal of clinical dermatology · 2018Review
- Epidermal PPARγ influences subcutaneous tumor growth and acts through TNF-α to regulate contact hypersensitivity and the acute photoresponse.Oncotarget · 2017Article
- Cancer and autoimmunity: Harnessing longitudinal cohorts to probe the link.Best practice & research. Clinical rheumatology · 2016Review
- Risk of Nonmelanoma Skin Cancer Associated With the Use of Immunosuppressant and Biologic Agents in Patients With a History of Autoimmune Disease and Nonmelanoma Skin Cancer.JAMA dermatology · 2016Article
- Article
- Inflammation and cancer: advances and new agents.Nature reviews. Clinical oncology · 2015Review
- Primary cutaneous anaplastic large cell lymphoma in a patient receiving adalimumab.JAAD case reports · 2015Article
- Long-term safety and efficacy of infliximab for the treatment of ankylosing spondylitis.Therapeutics and clinical risk management · 2015Review
- Intertoe Squamous Cell Carcinoma Developed in a Patient with Rheumatoid Arthritis under Etanercept Therapy.Case reports in medicine · 2015Article
- Tumor necrosis factor inhibitors - state of knowledge.Archives of medical science : AMS · 2014Article
- Skin cancer in organ transplant recipients: more than the immune system.Journal of the American Academy of Dermatology · 2014Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe risk of malignancies on TNF-α antagonists is controversial. The aim of this survey was to assess cancer risk on TNF-α antagonists in adult rheumatoid arthritis patients, including the five marketed drugs (infliximab, etanercept, adalimumab, golimumab and certolizumab) used in line with the New Drug Application. Furthermore, the relative interest of modified intention to treat or per protocol analyses to assess such sparse events remains unknown. METHODOLOGY/PRINCIPAL
findingsData sources were MEDLINE, CENTRAL, ISI Web of Science, ACR and EULAR meeting abstracts, scientific evaluation of the drugs leading to their marketing approval, and clinicaltrials.gov, until 31 December 2012.We selected double-blind randomized controlled trials in adult rheumatoid arthritis patients, including at least one treatment arm in line with New Drug Application. We performed random effect meta-analysis, with modified intention to treat and per protocol analyses. Thirty-three trials were included. There was no excess risk of malignancies on anti-TNF-α administered in line with New Drug Application in the per protocol model (OR, 0.93 95%CI[0.59-1.44]), as well as in the modified intention to treat model (OR, 1.27 95%CI[0.82-1.98]). There was a non-significant tendency for an excess non-melanoma skin cancer risk in both models (respectively, 1.37 [0.71-2.66] and 1.90 [0.98-3.67]). With fixed effect Peto model restricting to trials during at least 52 weeks, the overall cancer risk was respectively 1.60 [0.97-2.64] and 1.22 [0.72-2.08]. Whatever the model, modified intention to treat analysis led to higher estimations than per protocol analysis. The later may underestimate the treatment effect when assessing very sparse events and when many patients dropped out in placebo arms. In metaregression, there was no differential risk among the five drugs. CONCLUSIONS/SIGNIFICANCE: This study did not find any evidence for an excess cancer risk on TNF-α antagonists in adult rheumatoid arthritis patients, but an excess cancer risk after several years of exposure cannot be ruled out. Both modified intention to treat and per protocol analyses should be presented in such safety analyses.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.