Is Treatment with 6-Mercaptopurine for Colitis Associated with the Development of Colorectal Cancer?

Satchi, Mylan; Korelitz, Burton I.; Panagopoulos, Georgia; Bratcher, Jason; Yu, Christine; Atallah-Vinograd, Jean; Schneider, Jill E.

doi:10.1097/mib.0b013e318289664c

Cited by 11 publications

(13 citation statements)

References 9 publications

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“…Similarly, in a study of 188 patients with UC-related colorectal cancer and matched controls, there was no association between thiopurine use and colorectal cancer (OR = 2.1, 95%CI: 0.7-7.2)[66]. Several other studies have produced similar findings, confirming a lack of benefit for thiopurines in preventing CRC[43,67-74]…”

Section: Thiopurines In Chemopreventionmentioning

confidence: 81%

Thiopurines and inflammatory bowel disease: Current evidence and a historical perspective

Axelrad¹,

Roy²,

Lawlor³

et al. 2016

WJG

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The use of thiopurines in inflammatory bowel disease (IBD) has been examined in numerous prospective, controlled trials, with a majority demonstrating a clinical benefit. We conducted this review to describe the historical and current evidence in the use of thiopurines in IBD. A systematic search was performed on MEDLINE between 1965 and 2016 to identify studies on thiopurines in IBD. The most robust evidence for thiopurines in IBD includes induction of remission in combination with anti-tumor necrosis factor (anti-TNF) agents, and maintenance of remission and post-operative maintenance in Crohn’s disease. Less evidence exists for thiopurine monotherapy in induction of remission, maintenance of ulcerative colitis, chemoprevention of colorectal cancer, and in preventing immunogenicity to anti-TNF. Evidence was often limited by trial design. Overall, thiopurines have demonstrated efficacy in a broad range of presentations of IBD. With more efficacious novel therapeutic agents, the positioning of thiopurines in the management of IBD will change and future studies will analyze the benefit of thiopurines alone and in conjunction with these new medications.

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Section: Thiopurines In Chemopreventionmentioning

confidence: 81%

Thiopurines and inflammatory bowel disease: Current evidence and a historical perspective

Axelrad¹,

Roy²,

Lawlor³

et al. 2016

WJG

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“…Four of the cohort studies calculated incidence rate as the measure of hazard ratio (HRs) [25,29,30,32] and one presented rate ratio (RR)[31]. In terms of geographical settings of the studies, 8 studies were conducted in the Unites States[18,20,22-24,29-31], 9 in Europe[16,17,19,21,25,26,28,31,33], one in New Zealand[27] and one in South Africa[34].…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies reported CRC outcomes alone[16,17,22,24,26,28,31,32,34], one study reported dysplasia outcome alone[23], 3 reported CRC outcome and a combined CRC/dysplasia outcome[19,21,27], and the other 6 studies reported a combined outcome of CRC or dysplasia[18,20,25,29,30,33]. The characteristics of the included studies are outlined in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Use of thiopurine was associated with a reduction of CRC in cohort studies (n=6 [24,25,28-30,32], RR=0.96, 95%CI 0.94-0.98, P<0.01, Q=2.63, P for heterogeneity=0.756, I 2 =0.0%) but not case-control studies (n=6[16,17,19,21,22,24], RR=0.43, 95% CI 0.17-1.08, P=0.072, Q=14.38, P for heterogeneity=0.013, I 2 =65.2%). When pooled together, the relative risk is 0.70 (95%CI 0.46-1.09, P=0.111, Q=34.21, P for heterogeneity<0.001, I 2 =67.8%).…”

Section: Resultsmentioning

confidence: 99%

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Use of Thiopurines and Risk of Colorectal Neoplasia in Patients with Inflammatory Bowel Diseases: A Meta-Analysis

et al. 2013

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ObjectiveInflammatory bowel disease (IBD) is commonly treated with thiopurines such as azathioprine and mercaptopurine for the maintenance of remission. Studies examining chemopreventive of these medications on colorectal neoplasm in IBD patients have yielded conflicting results. We performed a meta-analysis to assess the role of thiopurines for this indication.MethodsWe performed a systematic search of PubMed, Web of Science, EMBASE and Cochrane to identify studies reporting colorectal neoplasm from IBD patients treated with thiopurines and conducted a meta-analysis of pooled relative risk (RR) using the random effects model.ResultsNine case-control and ten cohort studies fulfilled the inclusion criteria. The use of thiopurines was associated with a statistically significant decreased incidence of colorectal neoplasm (summary RR=0.71, 95% CI=0.54–0.94, p=0.017), even after adjustment for duration and extent of the disease, but there was high heterogeneity among studies (I 2=68.0%, p<0.001). The RR of advanced neoplasm (high-grade dysplasia and cancer) was 0.72 (95%CI=0.50–1.03, p=0.070) and that of cancer was 0.70 (95% CI=0.46–1.09, p=0.111) for thiopurine-treated patients. Heterogeneity of the studies was affected by the sample size (

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“…Twelve of the total 24 studies that reported data for any IBD patients without data separated for UC or CD. Twelve studies reported the effect of thiopurines on the risk of colorectal neoplasia in patients with UC.…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: thiopurines decrease the risk of colorectal neoplasia in patients with inflammatory bowel disease

Qiu

Mao

et al. 2017

Aliment Pharmacol Ther

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Is Treatment with 6-Mercaptopurine for Colitis Associated with the Development of Colorectal Cancer?

Abstract: We conclude that there is neither sufficient evidence currently to state that 6-MP is associated with an increased development of CRC, nor that it has a chemopreventive effect.

Cited by 11 publications

References 9 publications

Thiopurines and inflammatory bowel disease: Current evidence and a historical perspective

Thiopurines and inflammatory bowel disease: Current evidence and a historical perspective

Use of Thiopurines and Risk of Colorectal Neoplasia in Patients with Inflammatory Bowel Diseases: A Meta-Analysis

Systematic review with meta‐analysis: thiopurines decrease the risk of colorectal neoplasia in patients with inflammatory bowel disease

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