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Malignancies with anti-tumor necrosis factor-α therapy in IBD

The latest issue of the Alimentary Pharmacology & Therapeutics estimated the risk of malignancies with anti-tumor necrosis factor-α therapy in inflammatory bowel disease.

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Anti-tumor necrosis factor-α (TNFα) antibodies are efficacious in inflammatory bowel disease (IBD).

These drugs carry the theoretical risk of malignancy, particularly lymphoma, but no systematic review and meta-analysis has examined this issue.

Dr Ford and colleagues from the United Kingdom pooled data from all available placebo-controlled studies to estimate risk of malignancy with anti-TNFα therapy in IBD.

MEDLINE, EMBASE and the Cochrane central register of controlled trials were searched to 2013.

Randomized controlled trials (RCTs) comparing anti-TNFα therapy with placebo in adults with Crohn's disease (CD) or ulcerative colitis (UC) were eligible.

The RR of malignancy for patients receiving anti-TNFα therapy compared with placebo was 0.77
Alimentary Pharmacology & Therapeutics

Data were pooled to obtain a relative risk (RR) of malignancy with a 95% confidence interval (CI).

The search strategy identified 25,338 citations, of which 22 RCTs were eligible involving 7054 patients.

In total, there were 16 malignancies in 4135 IBD patients allocated to anti-TNFα, compared with 13 in 2919 patients randomized to placebo.

The team observed no cases of lymphoma in the active treatment group, compared with 3 in the control group.

The RR of malignancy for patients receiving anti-TNFα therapy compared with placebo was 0.77.

The team found that when 7 individuals with nonmelanoma skin cancer were excluded from the analysis, the RR was 0.90.

Dr Ford's team concludes, "Anti-TNFα therapy was not associated with an increased risk of malignancy in patients with IBD."

"However, no trials provided data for risk of malignancy beyond 1 year of treatment, meaning that an increased risk in the longer term cannot be excluded."

Aliment Pharmacol Ther 2014: 39(5): 447–458
11 February 2014

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