In the case of anti-TNF, the German BiKeR registry shows that 9 years of etanercept use in pediatric and adolescent rheumatoid arthritis patients did not observe new tumor or autoimmune risks during follow-up; however, the incidence of severe infections was higher compared to the control group that did not use biologics [332]; In the real world, infliximab and its biosimilars maintain long-term efficacy and safety consistent with the reference product [333, 334]. This evidence concerns the gene TNF and neoplasm.