Cancer risk of Janus kinase inhibitors and other advanced therapies in immune-mediated inflammatory diseases: a systematic review and Bayesian network meta-analysis of RCTs
Authors' conclusion
Across IMIDs, JAKi were consistently associated with higher malignancy risk relative to TNFi and standard care
Study context
- Population
- Adults with rheumatoid arthritis (RA), psoriasis/psoriatic arthritis (PsA) or inflammatory bowel disease in trials of licensed advanced therapies reporting malignancy outcomes
- Participants
- 164,824 adults305 studies
- Comparison
- JAKi vs other advanced therapies and standard care
- Outcome
- All malignancies including nonmelanoma skin cancer (incidence RR)
Methodological detailsclass-level network meta-analysis, Poisson models, phases II to IV RCTs and long-term extension studies, 264,100 person-years exposure, Searched MEDLINE, Embase, Cochrane Library and ClinicalTrials.gov from inception to February 2026
- Class-level network meta-analysis
- Poisson models
- Phases II to IV RCTs and long-term extension studies
- 264,100 person-years exposure
- Searched MEDLINE, Embase, Cochrane Library and ClinicalTrials.gov from inception to February 2026
Pooled result
As reported in the abstract
Malignancy, combined IMID network
Relative risk (95% CrI)
JAKivs TNFi
1.60(1.27–2.02)
JAKivs Standard care
1.85(1.38–2.47)
Further pooled results
Malignancy in RA, psoriasis (PsO)/PsA and inflammatory bowel disease (IBD) networks
- Similar directional findings across RA, PsO/PsA and IBD networks
Malignancy with IL-6, IL-17, IL-23, IL-12/23, CTLA-4 and CD20 (CD20)-targeting therapies
- Risks broadly comparable with TNFi
Absolute excess cancer risk, JAKi vs TNFi
- Standard-risk populations, cancers per 1000 PYE (negligible; ∼1 additional cancer per 27,000 PYE)
- +0.037
- Higher-risk populations, cancers per 1000 PYE (meaningful; ∼1 additional cancer per 147 PYE)
- +6.814
Original publication
Cancer risk of Janus kinase inhibitors and other advanced therapies in immune-mediated inflammatory diseases: a systematic review and Bayesian network meta-analysis of RCTs. Ann Rheum Dis. Published 10 July 2026. doi:10.
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