This article is more than 5 years old. Information may no longer be current.
Lymphoma risk elevated in IBD patients exposed to thiopurines
Click Here to Manage Email Alerts
Patients with inflammatory bowel disease on thiopurine therapy had an increased risk for lymphoma that abated after discontinuation of therapy, according to recent study data.
Using updated population-based data since an original meta-analysis, researchers calculated more accurate relative risk estimates of lymphoma in patients with IBD who were exposed to thiopurines, and also compared RRs between study type and former and current users. Eighteen relevant studies were analyzed after being sourced from database searches, conference abstracts and international publications with experimental groups that received azathioprine or 6-mercaptopurine.
Median therapy duration was 18 months before diagnosis of lymphoma. Pooled data indicated an overall standardized incidence ratio (SIR) for lymphoma of 4.49 (95% CI, 2.81-7.17). SIR was 2.43 (95% CI, 1.5-3.92) in the eight population studies and 9.16 (95% CI, 5.03-16.7) in the 10 referral studies (P<.05). Pooled SIR was 1.06 (95% CI, 0.81-1.4) for patients who were thiopurine naive, 1.42 (95% CI, 0.86-2.34) for patients who had prior exposure and 5.71 (95% CI, 3.22-10.1) for current users. Risk level became significant between 1 and 2 years of exposure (SIR=4.31 [95% CI, 1.85-10.1]).
Men had twice the risk as women (RR=2.05; P<.05), but both men (SIR=3.6; 95% CI, 2.68-4.83) and women (SIR=1.76; 95% CI, 1.08-2.87) had increased risk. Patients aged younger than 30 years had the highest RR (SIR=6.99; 95% CI, 2.99-16.4). Absolute risk was greatest in patients aged older than 50 years (1:377 cases per patient-year).
“We demonstrated that patients with IBD who are taking thiopurines have a nearly 6-fold higher incidence of lymphoma when compared to the general population,” the researchers concluded. “Additionally, we determined that use of thiopurines does not appear to result in a persistent elevated incidence of lymphoma after the medication is discontinued, suggesting that immunosuppression, rather than direct DNA damage, may be more of a factor in the development of excess lymphomas.”
Disclosure: See the study for a full list of relevant financial disclosures.
Click Here to Manage Email Alerts