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Risk of malignancies in patients with inflammatory bowel disease treated with thiopurines or anti‐TNF alpha antibodies

2014; Wiley; Volume: 23; Issue: 7 Linguagem: Inglês

10.1002/pds.3621

1099-1557

Florian Beigel, A Steinborn, Fabian Schnitzler, Cornelia Tillack, Simone Breiteneicher, Jestinah Mahachie John, Kristel Van Steen, Rüdiger P. Laubender, Burkhard Göke, Julia Seiderer, Stephan Brand, Thomas Ochsenkühn,

Celiac Disease Research and Management

ABSTRACT Purpose We aimed to analyse malignancy rates and predictors for the development of malignancies in a large German inflammatory bowel disease (IBD) cohort treated with thiopurines and/or anti‐tumour necrosis factor (TNF) antibodies. Methods De novo malignancies in 666 thiopurine‐treated and/or anti‐TNF‐treated IBD patients were analysed. Patients ( n = 262) were treated with thiopurines alone and never exposed to anti‐TNF antibodies (TP group). In addition, patients ( n = 404) were exposed to anti‐TNF antibodies (TNF+ group) with no (7.4%), discontinued (80.4%) or continued (12.1%) thiopurine therapy. Results In the TP group, 20 malignancies were observed in 18 patients compared with 8 malignancies in 7 patients in the TNF+ group (hazard ratio 4.15; 95% CI 1.82–9.44; p = 0.0007; univariate Cox regression). Moreover, 18.2% of all patients in the TP group ≥50 years of age developed a malignancy, compared with 3.8% of all patients <50 years of age ( p = 0.0008). In the TNF+ group, 6.5% of all patients ≥50 years of age developed malignancies compared with 0.3% of all patients <50 years of age ( p = 0.0007). In both groups combined, thiopurine treatment duration ≥4 years was associated with the risk for skin cancer ( p = 0.0024) and lymphoma ( p = 0.0005). Conclusions Our data demonstrate an increased risk for the development of malignancies in IBD patients treated with thiopurines in comparison with patients treated with anti‐TNF antibodies with or without thiopurines. Copyright © 2014 John Wiley & Sons, Ltd.