Bibliometric Analysis of the 100 Most-cited Articles About Tumour Necrosis Factor-α Inhibitor Therapy and Malignancy

Objective: Tumour necrosis factor-alpha (TNF-α) inhibitors are widely used to treat inflammatory rheumatic diseases, but their long-term association with malignancy remains uncertain. This study aimed to perform a bibliometric analysis of the most-cited publications investigating malignancy risk related to anti-TNF-α therapy. Methods: The Web of Science (WoS) Core Collection was searched using the terms ‘anti-TNF’ or ‘TNFi’ combined with ‘biologic therapy’, ‘malignancy’, ‘lymphoma’ and ‘non-melanoma skin cancer’, without time restrictions. Only original articles published in English were included, whilst reviews, case reports, editorials, letters, book chapters and conference abstracts were excluded. The 100 most-cited articles were analysed for publication trends, citation counts, authors, institutions, countries and collaboration networks. Bibliometric visualisation was performed using VOSviewer. Results: Among 2,288 retrieved publications, the 100 most-cited articles accumulated 6,171 citations. Publication activity increased after 2015. The most-cited study was the 2004 cohort study by Wolfe and Michaud. Annals of the Rheumatic Diseases published the highest number of influential articles. Karolinska Institutet and other Northern European institutions were major contributors, whilst the United States and Sweden led in publication output. Johan Askling was the most productive author. Co-authorship and keyword analyses demonstrated well-established collaboration networks within the field. Conclusion: This bibliometric analysis provides an overview of the literature on malignancy risk associated with TNF-α inhibitors. The findings describe publication trends, key contributors, and institutional and geographical distribution of research activity. These results may be useful for understanding the development of this research field and for guiding future studies on the long-term safety of biologic therapies.