Increasing Risk of Lymphoma Over Time in Crohn’s Disease but Not in Ulcerative Colitis: A Scandinavian Cohort Study

Olén, Ola; Smedby, Prof Karin E.; Erichsen, Rune; Pedersen, Prof Lars; Halfvarson, Prof Jonas; Everhov, Åsa H; Bryder, Nicklas; Askling, Johan; Ekbom, Prof Anders; Sachs, Michael; Sørensen, Prof Henrik Toft; Ludvigsson, Prof Jonas F

doi:10.1016/j.cgh.2023.04.001

Cited by 11 publications

(2 citation statements)

References 21 publications

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“…The high relative risk of HF in childhood-onset IBD (aHR 2.72) aligned with previous findings in childhood-onset IBD for stroke, 7 malignancy, 40 , 41 and death, 42 which could be attributed to the prominence of IBD in an age group (children) in which few individuals suffer from HF, but possible also to ascertainment bias because very few healthy children are evaluated for HF. In addition, more severe disease activity in childhood-onset patients may contribute to this finding.…”

Section: Discussionsupporting

confidence: 84%

Risk of heart failure in inflammatory bowel disease: a Swedish population-based study

Sun,

Yao,

Olén

et al. 2024

European Heart Journal

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Background and Aims Dysregulation of inflammatory and immune responses has been implicated in the pathogenesis of heart failure (HF). But even if inflammation is a prerequisite for inflammatory bowel disease (IBD), little is known about HF risk in IBD. Methods In this Swedish nationwide cohort, patients with biopsy-confirmed IBD were identified between 1969 and 2017 [n = 81,749, Crohn’s disease (CD, n = 24,303), ulcerative colitis (UC, n = 45,709), and IBD-unclassified (IBD-U, n = 11,737)]. Each patient was matched with up to five general population reference individuals (n = 382,190) and IBD-free full siblings (n = 95,239) and followed until 31 December 2019. Flexible parametric survival models estimated the adjusted hazard ratio (aHR) and standardized cumulative incidence for HF, with 95% confidence intervals (CI). Results There were 5,582 incident HF identified in IBD patients (incidence rate [IR]: 50.3/10,000 person-years) and 20,343 in reference individuals (IR: 37.9) during a median follow-up of 12.4 years. IBD patients had a higher risk of HF than reference individuals (aHR 1.19, 95% CI 1.15 to 1.23). This increased risk remained significant ≥20 years after IBD diagnosis, leading to one extra HF case per 130 IBD patients until then. The increased risk was also observed across IBD subtypes: CD (IR: 46.9 vs. 34.4; aHR 1.28 [1.20 to 1.36]), UC (IR: 50.1 vs. 39.7; aHR 1.14 [1.09 to 1.19]), and IBD-U (IR: 60.9 vs. 39.0; aHR 1.28 [1.16 to 1.42]). Sibling-controlled analyses showed slightly attenuated association (IBD: aHR 1.10 [1.03 to 1.19]). Conclusions Patients with IBD had a moderately higher risk of developing HF for ≥20 years after IBD diagnosis than the general population.

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Section: Discussionsupporting

confidence: 84%

Risk of heart failure in inflammatory bowel disease: a Swedish population-based study

Sun,

Yao,

Olén

et al. 2024

European Heart Journal

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“…The highest risks are observed in individuals undergoing combined therapy (immunomodulators and biologics) or second-line biologics. Importantly, the study also detects increased risks in patients who had not been exposed to these drugs before [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Follicular Lymphoma in a Crohn’s Disease Patient Treated With Azathioprine

Kottavadakkeel,

Farzina,

Rajaram

et al. 2023

Cureus

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Inflammatory bowel disease (IBD) is an autoimmune disorder marked by chronic inflammation affecting the intestines. Crohn's disease (CD) and ulcerative colitis (UC) fall under the IBD umbrella, necessitating diverse treatments, including steroids, immunomodulators like 6-mercaptopurine (6-MP) and azathioprine (AZA), and biological agents. The prolonged use of immunomodulators, such as AZA, is associated with an elevated risk of developing lymphomas. This case report centers on a 77-year-old gentleman regularly monitored by Gastroenterology, undergoing long-term AZA therapy for CD management. He presented with palate swelling and acute-on-chronic back pain, diagnosed with follicular lymphoma in the palate with metastasis. Palliative radiotherapy was administered for the paraspinal lesion, and the patient is currently stable. In conclusion, this case underscores the importance of recognizing the heightened risk of neoplasms, especially lymphomas, in patients undergoing prolonged immunomodulator therapy. It emphasizes the need for a vigilant and comprehensive approach to patient care, transcending conventional paradigms.

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Estimating cancer risk in immune-mediated inflammatory diseases exposed to varying doses of tumour necrosis factor inhibitors

Okabayashi,

Itaya,

Yamazaki

et al. 2024

J Gastroenterol

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Increasing Risk of Lymphoma Over Time in Crohn’s Disease but Not in Ulcerative Colitis: A Scandinavian Cohort Study

Cited by 11 publications

References 21 publications

Risk of heart failure in inflammatory bowel disease: a Swedish population-based study

Risk of heart failure in inflammatory bowel disease: a Swedish population-based study

A Case Report of Follicular Lymphoma in a Crohn’s Disease Patient Treated With Azathioprine

Estimating cancer risk in immune-mediated inflammatory diseases exposed to varying doses of tumour necrosis factor inhibitors

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