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Drug therapies and the risk of malignancy in Crohn's disease

The latest issue of the American Journal of Gastroenterology examines the risk of malignancy in Crohn's with various drug therapies.

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Dr Gary Lichtenstein and colleagues from Pennsylvania, USA assessed potential associations between malignancy and antitumor necrosis factor therapy in patients with Crohn's disease (CD), as this relationship is currently poorly defined.

Utilizing data from the Crohn's Therapy, Resource, Evaluation, and Assessment Tool (TREAT™) Registry, a prospective cohort study examining long-term outcomes of CD treatments in community and academic settings, infl uences of baseline patient/disease characteristics and medications were assessed by survival analysis and multivariate models.

Standardized incidence ratios and exact 95 % confi dence intervals were determined as the ratio of events observed vs expected.

Smoking was independently associated with the risk of malignancy
American Journal of Gastroenterology

The team enrolled 6,273 CD patients followed between 5 and 8 years, for all/currently active patients.

The team noted that crude cancer incidences were similar between infliximab- and other-treatments-only-exposed patients.

The research team demonstrated that baseline age, disease duration, and smoking but neither immunosuppressive therapy alone, infliximab therapy alone, nor their combination were independently associated with the risk of malignancy.

When compared with the general population, no significant increase in incidence was observed in any malignancy category.

In an exposure-based analysis, use of immunosuppressants alone or in combination with infliximab seemed to be associated with a numerically, but not significantly, greater risk of malignancy than did treatment with infliximab alone relative to treatment with neither.

Dr Lichtenstein and team conclude, "In the TREAT Registry, age, disease duration, and smoking were independently associated with increased risk of malignancy."

"Although results for immunosuppressant use were equivocal, no significant association between malignancy and infliximab was observed."

Am J Gastroenterol 2014; 109: 212–223
26 February 2014

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