{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T15:08:11Z","timestamp":1793372891876,"version":"4.5.0"},"reference-count":44,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,7,20]],"date-time":"2020-07-20T00:00:00Z","timestamp":1595203200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Over the last 2 decades, the usage of biological agents in the treatment of juvenile idiopathic arthritis (JIA) has been a successful and promising approach in controlling disease activity and preventing chronic sequelae. However, there are ongoing concerns about the long\u2010term safety data and side\u2010effect profile. We aimed to present preliminary data on the incidence of malignancy in patients with JIA treated with biological agents versus the general population rates in Turkey.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A single\u2010center hospital\u2010based cohort study was performed to analyze cancer occurrence among JIA patients treated with biologic agents during the observation period between January 2004 and May 2019. As reference data for direct standardization, age, gender, and calendar year\u2010specific incidence rates from the Turkish cancer registry were used. The standardized incidence ratio (SIR, ratio of cancers observed to expected) was generated with 95% confidence intervals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study sample consisted of 1023 JIA patients who had been treated with biologic or non\u2010biologic agents. In the biologic\u2010experienced group (n\u00a0=\u00a0656), the mean age (at the study) was 16.7\u00a0\u00b1\u00a05.6\u00a0years. The mean length of follow\u2010up was 9.9\u00a0\u00b1\u00a05.0\u00a0years. One cancer was detected within the observation period (SIR: 1.3, 95% CI: 0.06\u20106.3). The patient was an 18\u2010year\u2010old male who had previously received etanercept and tocilizumab until the diagnosis of the hematologic malignancy (SIR: 2.5, 95% CI: 0.1\u201012.6).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients treated with biologic agents appeared to have an increased rate of incident hematologic malignancy versus the general population in Turkey. However, before mentioning a clear causal relationship, other potential contributing factors should be taken into consideration.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1756-185x.13906","type":"journal-article","created":{"date-parts":[[2020,7,21]],"date-time":"2020-07-21T02:56:28Z","timestamp":1595300188000},"page":"1210-1218","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["A controversial topic in juvenile idiopathic arthritis: Association between biologic agents and malignancy"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0101-9585","authenticated-orcid":false,"given":"Oya","family":"Koker","sequence":"first","affiliation":[{"name":"Department of Pediatric Rheumatology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5365-3457","authenticated-orcid":false,"given":"Sezgin","family":"Sahin","sequence":"additional","affiliation":[{"name":"Department of Pediatric Rheumatology Cerrahpasa Medical School Istanbul University\u2010Cerrahpasa Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2400-6955","authenticated-orcid":false,"given":"Amra","family":"Adrovic","sequence":"additional","affiliation":[{"name":"Department of Pediatric Rheumatology Cerrahpasa Medical School Istanbul University\u2010Cerrahpasa Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7834-4909","authenticated-orcid":false,"given":"Mehmet","family":"Yildiz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Rheumatology Cerrahpasa Medical School Istanbul University\u2010Cerrahpasa Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8459-2872","authenticated-orcid":false,"given":"Kenan","family":"Barut","sequence":"additional","affiliation":[{"name":"Department of Pediatric Rheumatology Cerrahpasa Medical School Istanbul University\u2010Cerrahpasa Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3435-4336","authenticated-orcid":false,"given":"Bugra","family":"Gulle","sequence":"additional","affiliation":[{"name":"Department of Public Health Istanbul Faculty of Medicine Istanbul University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3740-6552","authenticated-orcid":false,"given":"Rukiye","family":"Eker Omeroglu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Rheumatology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1125-7720","authenticated-orcid":false,"given":"Ozgur","family":"Kasapcopur","sequence":"additional","affiliation":[{"name":"Department of Pediatric Rheumatology Cerrahpasa Medical School Istanbul University\u2010Cerrahpasa Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,7,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40744-016-0040-4"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.4274\/balkanmedj.2017.0111"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1546-0096-8-20"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0000000000000417"},{"issue":"6","key":"e_1_2_9_6_1","first-page":"819","article-title":"Treating juvenile idiopathic arthritis to target: recommendations of an international task force","volume":"77","author":"Ravelli A","year":"2018","journal-title":"Ann Rheum Dis"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1546-0096-12-13"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-019-1950-7"},{"key":"e_1_2_9_9_1","first-page":"127","article-title":"Challenges in the management of juvenile idiopathic arthritis with etanercept","volume":"3","author":"Pain CE","year":"2009","journal-title":"Biologics"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1546-0096-8-23"},{"key":"e_1_2_9_11_1","unstructured":"U.S. Food and Drug Administration.Cancer warnings required for TNF blockers 2009. 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