#5-17E. Weighing the Risks: JAK Inhibitors, IL-6 Inhibitors, and Non-Melanoma Skin Cancer in RA (Arthritis Rheumatol, 2026)

How should rheumatologists weigh the risk of non-melanoma skin cancer (NMSC) when initiating advanced therapies for rheumatoid arthritis? This episode delves into a national prospective cohort study from the UK that compared the risk of first-ever NMSC between patients initiating Janus kinase inhibitors (JAKi) and interleukin-6 receptor inhibitors (IL-6Ri). By linking registry data with national cancer records, researchers observed that while the incidence of NMSC was slightly higher in the JAKi cohort, the inverse probability of treatment-weighted hazard ratio (1.64) did not reach statistical significance over a median follow-up of 3.3 years. Crucially, the absolute risk increase is minimal—amounting to approximately one additional NMSC case for every 307 patients treated with a JAKi for one year. When critically appraising this study, we must note that the sample size was insufficient to evaluate the risks associated with individual JAK inhibitors, such as tofacitinib. Nevertheless, for physicians, these findings provide essential real-world context; while the NMSC risk is clinically small, it underscores the importance of personalized risk-benefit discussions and routine counseling on UV protection and skin cancer screening when prescribing JAK inhibitors in daily practice.

Citation: Tian Z, Kearsley-Fleet L, Zhao SS, Galloway J, Lunt M, Watson K, Azadbakht N, Hyrich KL. Non-melanoma skin cancer risk with Janus kinase inhibitors compared to interleukin-6 receptor inhibitors in rheumatoid arthritis: results from a national cohort study. Arthritis & Rheumatology. 2026.

DOI: 10.1002/art.70272

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.