IBD Treatment Could Increase Risk of Lymphoma

Thiopurines and anti–tumor necrosis factor (TNF) agents were associated with a small but statistically significant increase in the risk of lymphoma among patients with inflammatory bowel disease (IBD), according to a recent study.

In their nationwide cohort study, the researchers assessed the incidence of lymphoma among 189,289 patients with IBD using data from the French National Health Insurance databases (median age 43 years, 54% women). Patients were stratified based on exposure to thiopurine monotherapy (n=50,405), anti-TNF monotherapy (n=30,294), combination therapy (n=14,229), or never exposed to either therapy (n=123,069).
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During the median 6.7 years of follow-up, 336 incidents of lymphoma occurred. A total of 220 cases occurred in patients never exposed to either therapy, 70 occurred in patients exposed to thiopurine monotherapy, 32 occurred in patients exposed to anti-TNF monotherapy, and 14 occurred in patients exposed to combination therapy.

The risk of lymphoma was higher among patients exposed to thiopurine monotherapy (adjusted hazard ratio [aHR] 2.41), anti-TNF monotherapy (aHR 2.41), or combination therapy (aHR 6.11) compared with those never exposed to either therapy.

In addition, the risk for lymphoma was higher among patients exposed to combination therapy compared with those exposed to either thiopurine or anti-TNF monotherapy.

“Among adults with IBD, the use of thiopurine monotherapy or anti-TNF monotherapy was associated with a small but statistically significant increased risk of lymphoma compared with exposure to neither medication, and this risk was higher with combination therapy than with each of these treatments used alone,” the researchers concluded. “These findings may inform decisions regarding the benefits and risks of treatment.”

—Melissa Weiss

Reference:

Lemaitre M, Kirchgesner J, Rudnichi A, et al. Association between use of thiopurines or tumor necrosis factor antagonists alone or in combination and risk of lymphoma in patients with inflammatory bowel disease [November 7, 2017]. JAMA. doi:10.1001/jama.2017.16071.