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 18 February 2018

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News

Thiopurines vs tumor necrosis factor antagonists and lymphoma risk in IBD

This week's issue of the Journal of the American Medical Association assessed the risk of lymphoma associated with thiopurines and anti-TNF agents, used alone or in combination, for the management of IBD.

News image

An increased risk of lymphoma has been reported among patients receiving thiopurines for inflammatory bowel disease (IBD).

The risk of lymphoma associated with anti–tumor necrosis factor (TNF) agents either alone or in combination with thiopurines is uncertain.

Dr Magali Lemaitre and colleagues assessed the risk of lymphoma associated with thiopurines and anti-TNF agents, used alone or in combination, for the management of IBD.

Nationwide cohort study based on French National Health Insurance databases. Patients aged 18 years or older identified with IBD were included from 2009 through 2013, and followed up until 2015.

At each time of the follow-up, patients were categorized as being exposed to thiopurine monotherapy, anti-TNF monotherapy, or combination therapy, or being unexposed.

The risk of lymphoma was higher among those exposed to thiopurine monotherapy
Journal of the American Medical Association

The researchers' primary outcome was incident lymphoma.

Among the 189,289 patients included and followed up for almost 7 years, 123,069 were never exposed during follow-up, 50,405 were exposed to thiopurine monotherapy, 30,294 to anti-TNF monotherapy, and 14,229 to combination therapy.

Overall, 336 lymphoma cases occurred, of which 220 were in unexposed patients, 70 in patients exposed to thiopurine monotherapy, 32 in patients exposed to anti-TNF monotherapy, and 14 in patients exposed to combination therapy.

The researchers found that, compared with unexposed patients, the risk of lymphoma was higher among those exposed to thiopurine monotherapy, anti-TNF monotherapy, or combination therapy.

The team's risk was higher in patients exposed to combination therapy vs those exposed to thiopurine monotherapy or anti-TNF monotherapy.

Dr Lemaitre's team conclude, "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."

"These findings may inform decisions regarding the benefits and risks of treatment."

JAMA 2017;318(17):1679-1686
10 November 2017

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