Managing IBD in patients with previous cancers

Minnis-Lyons, Sarah E; Aiken, Zara; Chow, Shien; Din, Shahida

doi:10.1136/flgastro-2022-102187

Cited by 5 publications

(7 citation statements)

References 68 publications

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“…If combination therapy is necessary, methotrexate should be preferred. 77 , 78 While newer gut-selective biologics appear safe, a firm conclusion cannot be made based on current data.…”

Section: Resultsmentioning

confidence: 99%

Iranian Consensus Guideline for Pharmacotherapy with Biologics and Small Molecules Drugs in Adults with Inflammatory Bowel Diseases

Khoshnam‐Rad

Vahedi

Sadeghi

et al. 2023

Middle East J Dig Dis

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Background: Pharmacotherapy with biologics and small molecules, as the more effective therapies for moderate to severe ulcerative colitis (UC) and Crohn’s disease (CD), is complex. Choosing the best methods for their utilization in order to induce and maintain remission are critical for practicing gastroenterologists. We aimed to develop an Iranian consensus on the management of inflammatory bowel disease (IBD) patients with biologics and small molecules. Methods: A Delphi consensus was undertaken by experts who performed a literature summary and voting process. Quality of evidence was assessed using the Grading and Recommendations Assessment, Development, and Evaluation; and an additional risk of bias-protocol. Results: Following an extensive search of the literature, 219 studies were used to determine the quality of the evidence. After three rounds of voting, consensus (defined as≥80% agreement) was reached for 87 statements. Conclusion: We considered different aspects of pharmacotherapy in this consensus. This guideline, along with clinical judgment, can be used to optimize management of IBD patients.

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“…If combination therapy is necessary, methotrexate should be preferred. 77 , 78 While newer gut-selective biologics appear safe, a firm conclusion cannot be made based on current data.…”

Section: Resultsmentioning

confidence: 99%

Iranian Consensus Guideline for Pharmacotherapy with Biologics and Small Molecules Drugs in Adults with Inflammatory Bowel Diseases

Khoshnam‐Rad

Vahedi

Sadeghi

et al. 2023

Middle East J Dig Dis

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“…Given that treatment in IBD often calls for long‐term immunosuppression, treatment decisions in patients perceived to be at high risk of malignancy or infection by the treating physician are often weighted towards strategies which mitigate against this risk 44 . Prescribing practices in IBD may therefore introduce a selection bias that was unable to be measured and accounted for in the results of this analysis.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for malignancy and serious infection in patients with inflammatory bowel disease: a retrospective analysis

Tassone,

Basnayake,

Wright

et al. 2023

Internal Medicine Journal

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BackgroundPatients with inflammatory bowel disease (IBD) are at increased risk of malignancy and infection compared to the general population.AimsWe aim to identify risk factors for malignancy or serious infection in our IBD cohort.MethodsPatients with IBD from a single tertiary referral centre were included. Demographic and clinical details, including immunosuppressant exposure, were collected and medical records retrospectively screened for adverse events, including malignancy or infection requiring hospitalisation. Logistic regression was used to evaluate risk factors for adverse events.ResultsFive hundred and forty‐nine patients with IBD (340 Crohn disease (CD) and 209 ulcerative colitis (UC)) were studied. Forty‐eight malignancies, including 39 (81.3%) non‐melanoma skin cancers, 3 (6.3%) haematologic malignancies and 6 (15.4%) solid‐organ malignancies, were identified, and 92 cases of serious infection were detected. IBD duration (odds ratio (OR) = 1.08; 95% confidence interval (CI) = 1.03–1.13) and ileocolonic CD (OR = 4.96; 95% CI = 1.13–21.71) were associated with increased odds of overall cancer. Compared with patients not previously exposed to the given class of immunosuppression assessed, the development of overall malignancy was not higher with thiopurine exposure (OR = 1.00; 95% CI = 0.50–2.24) or anti‐tumour necrosis factor‐alpha (TNF‐α) exposure (OR = 0.78; 95% CI = 0.37–1.64). Similarly, compared with patients not exposed, infection risk was not affected by thiopurine (OR = 0.74; 95% CI = 0.46–1.20) or anti‐TNF exposure (OR = 0.60; 95% CI = 0.38–0.95).ConclusionsFactors including ileocolonic CD and increasing IBD duration were associated with higher malignancy risk in this cohort. Compared with non‐exposure, patients exposed to thiopurines were not at increased risk of malignancy or serious infection. Similarly, patients exposed to anti‐TNF treatment did not experience increased rates of malignancy or serious infection compared to patients not exposed to this treatment.

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“…Consequently, there is limited evidence regarding the potential for cancer recurrence risk associated with biologics. [ 85 86 87 ]…”

Section: Patient and Disease Characteristicsmentioning

confidence: 99%

“…Real-world data and experience with newer biologics are comparatively briefer than those for anti-TNF therapy; nevertheless, it appears that vedolizumab and ustekinumab, as supported by the limited available data on IBD patients and data extrapolated from non-IBD studies in the case of ustekinumab, are not linked to an increased risk of cancer recurrence. [ 86 ]…”

Section: Patient and Disease Characteristicsmentioning

confidence: 99%

Selecting first-line advanced therapy for ulcerative colitis: A clinical application of personalized medicine

Mukhtar,

Mosli

2024

Saudi Journal of Gastroenterology

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Ulcerative colitis (UC) is a chronic autoimmune inflammatory disease that affects the colon, leading to symptoms of bloody diarrhea, abdominal cramps, and urgency. The treatment of UC has evolved over the past few decades from locally active anti-inflammatory compounds to more selective therapies that target specific arrays of the immune system. The challenge of selecting the first advanced therapy became apparent in this rapidly expanding landscape of medications. No current investigational tools, such as genetic, immunologic, or biological markers, can guide the identification of the safest and most effective therapeutic option for each patient. Hence, physicians must carefully assess patient/disease characteristics and match them with the most suitable drug through a clinically driven assessment. In this paper, we outline patient and drug characteristics that play a role in selecting first-line advanced therapies for UC and propose an algorithm for selection.

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Managing IBD in patients with previous cancers

Cited by 5 publications

References 68 publications

Iranian Consensus Guideline for Pharmacotherapy with Biologics and Small Molecules Drugs in Adults with Inflammatory Bowel Diseases

Iranian Consensus Guideline for Pharmacotherapy with Biologics and Small Molecules Drugs in Adults with Inflammatory Bowel Diseases

Risk factors for malignancy and serious infection in patients with inflammatory bowel disease: a retrospective analysis

Selecting first-line advanced therapy for ulcerative colitis: A clinical application of personalized medicine

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