This nationwide French cohort study examined whether duration of targeted therapy exposure (TNFi, IL-17i, IL-12/23i, IL-23i, JAKi) affects cancer risk in 56,591 adults with spondyloarthritis (including psoriatic arthritis and axial SpA), followed for a median of 5.0 years (2014–2024).
Exposure >6 months/year vs. ≤6 months/year was associated with a **lower** overall cancer risk (wHR 0.86, 95% CI 0.75–0.99), driven primarily by hematological malignancies (wHR 0.65, 95% CI 0.42–0.99); no significant reduction was seen for solid cancers (wHR 0.92, 95% CI 0.79–1.07). Of 1,224 total cancers, 1,029 were solid and 116 hematological. Cumulative multi-year exposure was not associated with cancer risk.
- **Observational design**: residual confounding cannot be excluded despite inverse probability weighting. - **Database-based exposure**: therapy adherence is inferred from insurance claims, not directly measured. - **Heterogeneous SpA subtypes**: pooling psoriatic arthritis, axial SpA, and other subtypes may obscure subgroup-specific risks.
Clinicians can reassure patients with SpA that prolonged targeted therapy use is not associated with increased cancer risk — and may even lower hematological malignancy risk. Cumulative years of exposure should not, on its own, prompt treatment discontinuation over cancer concerns.
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