Immunomodulators heighten risk for high-grade cervical neoplasia, cancer in women with IBD
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Key takeaways:
- Risk for cervical intraepithelial neoplasia and cancer increased with each year of exposure to immunomodulators.
- Cumulative exposure to biologic agents or combination therapy did not increase risk.
Cumulative exposure to immunomodulators increased the risk for high-grade cervical intraepithelial neoplasia and cervical cancer in women with inflammatory bowel disease, according to data from Alimentary Pharmacology & Therapeutics.
“There is growing evidence that cervical neoplasia risk is increased in women with IBD,” Joany E. Kreijne, MD, from the department of gastroenterology and hepatology at Erasmus University Medical Center, and colleagues wrote. “Immunosuppressive drugs may be involved in induction of carcinogenesis and accelerated progression through preneoplastic stages due to impaired detection of oncogenic signals (immunosurveillance). The basis of the increased risk of cervical neoplasia in IBD has not been fully elucidated and the role of immunosuppressive drugs in this association is not well understood.”
To investigate the link between use of immunomodulators and biologic agents and development of moderate- to high-grade cervical dysplasia and cervical cancer, Kreijne and colleagues analyzed 1,981 women with IBD (median age, 42 years; 67% Crohn’s disease) using data from the Dutch IBD biobank and a nationwide cytopathology database.
During a median follow-up of 17.2 years, 67% of patients were exposed to treatment with an immunosuppressive drug. Of those, 89% received an immunomodulator, 61% a biologic agent and 49% either subsequent or simultaneous treatment with both.
Further analysis showed 99 women developed high-grade cervical intraepithelial neoplasia (IR = 2.73 per 1,000 person-years; 95% CI, 2.23-3.31), of whom 68 were exposed to immunosuppressive drugs (IR = 3.03; 95% CI, 2.37-3.82) and 31 were never exposed (IR = 2.23; 95% CI, 1.57-3.18).
Extended Cox-regression analysis revealed the risk for high-grade cervical intraepithelial neoplasia increased with each year of exposure to immunomodulators (HR = 1.16; 95% CI, 1.08-1.25). Conversely, researchers reported no significant association between cumulative exposure to biologic agents or combined therapy and high-grade cervical intraepithelial neoplasia.
Additional risk factors included smoking (HR = 2.73; 95% CI, 1.77-4.37) and 5-year screening frequency (HR = 1.74; 95% CI, 1.33-2.27).
“Long-term exposure to immunomodulators is associated with an increased risk of [high-grade cervical intraepithelial neoplasia] in women with IBD,” Kreijne and colleagues concluded. “Physicians should stress the importance of HPV vaccination and cervical cancer screening for all women with IBD. These results imply that further investigation is required to assess the benefit of intensified screening in women with IBD on long-term immunomodulator treatment.”
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