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No increased cancer risk associated with immunosuppressants, anti-TNFs in IBD patients with cancer history
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Inflammatory bowel disease patients with a history of cancer who were subsequently exposed to an anti-tumor necrosis factor agent or antimetabolite were not found to have an increased risk for new or recurrent cancer in a recent study.
“Most of our understanding about the rates and types of malignancy associated with the use of immunosuppression in patients with IBD comes from studies of individuals who had no history of cancer,” the researchers wrote. “Little is known about the risk of subsequent malignancy in IBD patients with a prior diagnosis of cancer who are exposed to immunosuppressive agents.”
The investigators retrospectively analyzed data on 333 IBD patients treated at eight academic medical centers who developed cancer and afterward were treated with anti–TNF-alpha monotherapy (n = 55), antimetabolite monotherapy (thiopurine, n = 71; methotrexate, n = 7), combination therapy with an anti–TNF-alpha and an antimetabolite (thiopurine, n = 35; methotrexate, n = 16), or had no subsequent exposure to an immunosuppressive agent (controls, n = 149). Development of incident cancer served as the primary outcome.
Some baseline demographic characteristics differed between groups; significantly more controls had UC (P = .0001).
Overall, 90 patients (27%) developed incident cancer during follow-up (13.2% developed a new cancer, 14.4% developed a recurrent cancer and 2.4% developed a new and recurrent cancer). There were no differences in time to subsequent cancer or type of incident cancer between treatment groups.
After adjusting for recurrence risk type of prior cancer, risk for incident cancer was comparable between treatment groups and controls:
- anti–TNF-alpha monotherapy (HR = 0.32; 95% CI, 0.09-1.09);
- antimetabolite monotherapy (HR = 1.08; 95% CI, 0.54-2.15); and
- combination therapy (HR = 0.64; 95% CI, 0.26-1.59).
Time to subsequent cancer was also comparable between groups after adjusting for recurrence risk type of prior cancer.
“Prospective data are needed to confirm these findings, but our study supports growing evidence for the relative safety of anti–TNF-[alpha] and antimetabolites in IBD patients with a history of cancer,” the researchers concluded. – by Adam Leitenberger
Disclosures: Axelrad reports no relevant financial disclosures. Please see the study for a full list of all other researchers’ relevant financial disclosures.
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