These authors share senior authorship.
Risk of malignancies in patients with inflammatory bowel disease treated with thiopurines or anti-TNF alpha antibodies
Article first published online: 30 APR 2014
Copyright © 2014 John Wiley & Sons, Ltd.
Pharmacoepidemiology and Drug Safety
Volume 23, Issue 7, pages 735–744, July 2014
How to Cite
Beigel, F., Steinborn, A., Schnitzler, F., Tillack, C., Breiteneicher, S., John, J. M., Van Steen, K., Laubender, R. P., Göke, B., Seiderer, J., Brand, S. and Ochsenkühn, T. (2014), Risk of malignancies in patients with inflammatory bowel disease treated with thiopurines or anti-TNF alpha antibodies. Pharmacoepidem. Drug Safe., 23: 735–744. doi: 10.1002/pds.3621
Prior postings and presentations:
Parts of this work have been presented as an oral presentation at the United European Gastroenterology Week 2011 in Stockholm and published in Gut Oct 2011; 60, Suppl. 3, A35, OP147, as an oral poster presentation at the 6th Congress of European Crohn's and Colitis Organisation 2011 in Dublin and published in JCC Feb 2011; Vol. 5, Issue 1, S134, P293 and as a poster presentation at Digestive Disease Week 2011 in Chicago and published in Gastroenterology 2011; 140, (5), Suppl. 1, S773.
- Issue published online: 4 JUL 2014
- Article first published online: 30 APR 2014
- Manuscript Accepted: 10 MAR 2014
- Manuscript Revised: 8 JAN 2014
- Manuscript Received: 28 MAY 2013
- Deutsche Forschungsgemeinschaft. Grant Numbers: DFG, BE 4490/2-1, DFG, BR 1912/6-1
- Deutsche Forschungsgemeinschaft
- Else Kröner-Fresenius-Stiftung. Grant Number: 2010_EKES.32
- inflammatory bowel disease;
- anti-TNF antibodies;
- skin cancer;
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.
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.
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).
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.