Lymphoma remains ‘rare event’ in children with IBD
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AUSTIN, Texas — While a small risk for lymphoma exists in children with inflammatory bowel disease, occurrences are relatively rare, according to data presented at the Crohn’s and Colitis Congress.
“The risk of malignancies is an important concern associated with the medical therapies that we use to treat inflammatory bowel disease,” Matthew Egberg, MD, MPH, MMSc, an assistant professor within the department of pediatrics, division of gastroenterology at University of North Carolina at Chapel Hill, said during his presentation.
Egberg said that although there have been benefits shown in using anti-TNF therapies in children, use may be limited due to concerns associated with lymphoma risks.
Egberg and colleagues aimed to evaluate the incidence rate and absolute risk for lymphoma in 9,281 pediatric patients with IBD (62% Crohn’s disease; median age, 13.7 years) who were previously exposed to biologics.
Additionally, the researchers wanted to characterize the demographics and medication exposures in those children diagnosed with lymphoma.
The researchers conducted a retrospective cohort case series using data from the IQVIA PharMetrics Adjudicated Administrative Claims Database – a national, geographically diverse insurance claims database that consists of 100 health care plans – to assess lymphoma diagnosis.
Seventy percent of the children had been exposed at least once to steroids, while 34% were exposed to a thiopurine and 15% to an anti-TNF.
Additionally, 25% had been exposed to immune modulator monotherapy and 8% to anti-TNF monotherapy.
There were three cases of lymphoma, which equated to 11.8 cases per 100,000 person-years (absolute risk = 1/3,093).
“Using a national, geographic and diverse insurance claims database cohort of over 9,000 pediatric IBD patients, we observed an extremely low incidence rate and absolute risk of lymphoma,” Egberg said.
Each case involved a male, two of whom were aged 18 years and the third was aged 13 years. None of the patients had been previously exposed to either an immune modulator or anti-TNF agent.
Egberg did note that there were some limitations to the study.
“The use of insurance claims data raise the possibility of misclassification of exposure and/or outcome related to a lack of clinical detail in this type of data,” he said. “Important variables that may also influence outcomes are also not captured in the data including patient disease severity, medication history ... and patient family history. It is also important to note that it was a 2-year median follow-up.”
The rarity of the available data adds to what is already out there, according to Egberg.
“Our findings add to existing literature and suggests there is still a small measurable risk that patients, families and clinicians need to be aware of and consider when discussing treatment strategies,” he said. “It is also important to explain treatment risks to patients and families using understandable language.” – by Ryan McDonald
Reference:
Egberg M, et al. Abstract 1. Presented at: Crohn’s & Colitis Congress; Jan. 23-25, 2020; Austin, Texas.
Disclosure: Egberg reports no relevant financial disclosures.