Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine

Kandiel, Ahmed; Fraser, Alan G.; Korelitz, Burton I.; Brensinger, Colleen M.; Lewis, James D.

doi:10.1136/gut.2004.049460

Cited by 735 publications

(478 citation statements)

References 21 publications

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“…Similarly, no preventive effect (HR, 1.06-1.3) of azathioprine/6-mercaptopurine use could be demonstrated during an 8-year follow-up in a more recent study [94] . Of note, azathioprine was reported to be associated with a 4-fold elevated risk of lymphomas in some previous studies [95] and a recent meta-analysis [96] . Although IBD itself was not associated with an increased risk for lymphoma [97] , disease severity cannot be excluded as a confounding variable.…”

Section: Chemoprevention In Ibd-is It Possible?mentioning

confidence: 99%

Risk for colorectal cancer in ulcerative colitis: Changes, causes and management strategies

Lakatos¹,

Lakatos²

2008

WJG

373

245

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Since the first report of an inflammatory bowel disease (IBD) case associated with colorectal cancer (CRC) by Crohn and Rosenberg [1] , significant efforts have been made to elucidate this presumed association. Nowadays, the association between IBD and the increased risk for CRC is widely accepted. Although CRC, complicating ulcerative colitis and Crohn's disease, accounts only for 1%-2% of all cases of CRC in the general population, it is considered a serious complication of the disease and accounts for approximately 10%-15% of all deaths in IBD patients [2] . The age at diagnosis of CRC associated with IBD is 15-20 years earlier compared to sporadic cancers. In the meta-analysis by Eaden et al [3] , the average age at diagnosis was 43.2 years. Similarly, in a recent publication from Eastern Europe [4] , it was found to be 50.9 years, 10-15 years younger compared to sporadic CRC cases from the same area (62.2 years) [5] . According to US [6] and Canadian [7] publications, almost two-thirds of the affected patients were males, yet results are conflicting [4,8] . In addition, the frequency of multiple CRCs is higher than in patients with sporadic CRC [9] .The increased risk of CRC in UC is almost a universal finding [3,[10][11][12][13] , yet the extent of this risk varies considerably with differences in study design and geographic area. The initial reports were published by tertiary gastroenterology centers, thus the high risk detected might have been a consequence of referral bias and overinterpretation due to the high percentage of extensive and chronically active cases in these cohorts. Results of population-based studies are more reliable; however, several geographical and ethnic differences have been noted.The report of the meta-analysis by Eaden et al [3] in 2001 was one of several milestones in this subject. The incidence of UC-associated CRC was estimated based on 116 articles involving 54 478 patients in whom 1698 CRC cases were detected. This was a mixture of referral center-based, hospital-based, and population-based studies of variable methodological qualities and levels of detail. The reported incidence was higher in the US AbstractThe risk of colorectal cancer for any patient with ulcerative colitis is known to be elevated, and is estimated to be 2% after 10 years, 8% after 20 years and 18% after 30 years of disease. Risk factors for cancer include extent and duration of ulcerative colitis, primary sclerosing cholangitis, a family history of sporadic colorectal cancer, severity of histologic bowel inflammation, and in some studies, young age at onset of colitis. In this review, the authors discuss recent epidemiological trends and causes for the observed changes. Population-based studies published within the past 5 years suggest that this risk has decreased over time, despite the low frequency of colectomies. The crude annual incidence rate of colorectal cancer in ulcerative colitis ranges from approximately 0.06% to 0.16% with a relative risk of 1.0-2.75. The exact mechanism for this chang...

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Section: Chemoprevention In Ibd-is It Possible?mentioning

confidence: 99%

Risk for colorectal cancer in ulcerative colitis: Changes, causes and management strategies

Lakatos¹,

Lakatos²

2008

WJG

373

245

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“…67 Secondly, there is a fourfold documented increase in the risk of lymphoma with these medications which can present in the oral cavity. 68,69 It should be noted, however, that there is only a very small absolute increase in the risk of lymphoma occurrence.…”

Section: -Asasmentioning

confidence: 99%

Inflammatory bowel disease and oral health

Chandan

Thomas

2017

BDJ Team

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Risk factors involved in IBDIBD is thought to result from inappropriate and ongoing activation of the mucosal immune system facilitated by defects in both the intestinal epithelium and mucosal immune system. 5 There are both genetic and environmental factors implicated in the aetiology of IBD. 6 Although traditionally associated with the developed world, recent epidemiological studies suggest an increasing incidence in rapidly developing countries, especially in South-East Asia. 7 In addition, the increased risk of IBD in the immigrant populations in the West suggests environment has a role in the development of IBD. 8 Genetic Detailed genetic mapping has identified specific genetic changes on chromosome 16 carried in families which appear linked to CD, however no significant changes have been mapped as of yet to UC. 9,10 Specifically, variants of the NOD2 gene provide the strongest association with susceptibility to CD. NOD2 plays a key role in regulating the gut mucosal barrier involving, specifically, the microbiota, as well as the related response by the innate and adaptive immune system. The IBDchip European Project showed NOD2 has been implicated in ileal location colitis with stenosing and penetrating disease behaviour. 11 A genome wide association study has also identified a strong link between the IL23R gene and CD. 12 The gene in particular codes for interleukin 23 that plays a role in regulating innate immunity within the intestine. 13 Cigarette smoking Unusually, cigarette smoking is associated with decreased rates of incidence of UC and has been associated with protective features to prevent further flare-ups of the condition 14-19 such as relapses, 20 ©SEBASTIAN KAULITZKI/Science Photo Library/Getty J. S. Chandan 1 and T. Thomas 1 summarise the treatments for inflammatory bowel disease (IBD) and how anti-inflammatory medications can have side effects that affect the oral cavity.

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“…22 Whether or not treatment with thiopurines increases the risk of lymphoma has long been debated, and a recent meta-analysis concluded that the risk of developing lymphoma increased fourfold in IBD patients on immunosuppressives. 23 However, the absolute risk is small and early introduction of immunosuppressive therapy is beneficial due to the decreased need for corticosteroids and better disease control.…”

Section: Immunosuppressivesmentioning

confidence: 99%

Inflammatory Bowel Disease in Older People

Grimpen¹,

Pavli

2008

Pharmacy Practice and Res

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Inflammatory bowel disease (IBD) can affect patients of all ages. The majority of patients are diagnosed in the second or third decade of life, but a minority develop the disease at an advanced age. Diagnosis can be delayed due to the preconception that IBD mainly affects young people, and the broader spectrum of differential diagnoses in the elderly. Management and treatment options are similar to those in younger patients but adverse reactions and drug interactions may be of greater significance in the elderly. Precluding treatment with anti-tumour necrosis factor drugs on grounds of previous infection with tuberculosis or viral hepatitis, comorbidities or previous malignancy -factors often found with advanced age -can make treatment challenging. The increased risk of bowel cancer in IBD warrants regular screening, especially in the elderly as their absolute risk of cancer is higher.

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Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine

Cited by 735 publications

References 21 publications

Risk for colorectal cancer in ulcerative colitis: Changes, causes and management strategies

Risk for colorectal cancer in ulcerative colitis: Changes, causes and management strategies

Inflammatory bowel disease and oral health

Inflammatory Bowel Disease in Older People

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