Tumor safety of biologic agents and targeted therapies in immune-mediated inflammatory arthritides

Immune-mediated inflammatory arthritides (IMIA), including rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and juvenile idiopathic arthritis, are chronic immune-driven disorders in which long-term malignancy safety has become a key determinant of therapeutic decision-making. Patients with IMIA are not oncologically neutral at baseline; persistent inflammatory burden, smoking exposure, age, and cumulative immunosuppressive treatment all modify cancer susceptibility.

Against this background, biologic and targeted synthetic disease-modifying antirheumatic drugs may both reduce inflammation-associated oncogenic pressure and attenuate antitumor immune surveillance. In this narrative review, we synthesize current evidence on tumor safety across major biologic classes and Janus kinase inhibitors, with emphasis on data emerging through early 2026.

Overall, most biologic therapies appear broadly reassuring with respect to overall malignancy, although non-melanoma skin cancer remains the most reproducible treatment-associated signal, particularly with tumor necrosis factor inhibitors and possibly abatacept. Rituximab retains a favorable profile in patients with prior lymphoproliferative disease, whereas IL-6 and IL-17/23 pathway inhibitors appear largely neutral or reassuring in currently available datasets.