Immunosuppression & cancer risk

July 9, 2024

Issue 14

Clinical Question

Does immunosuppression increase the risk of cancer in IBD patients with a history of cancer?

Editor’s Bottom Line

Larger sample sizes are needed to provide definitive answers about specific malignancies. However, these data are reassuring in that no significant association was seen between immunosuppressive exposure and new or recurrent cancer in a high-risk IBD cohort.

Reference

Itzkowitz SH, Jiang Y, Villagra C, et al. Safety of Immunosuppression in a Prospective Cohort of Inflammatory Bowel Disease Patients With a HIstoRy of CancEr: SAPPHIRE Registry. Clin Gastroenterol Hepato.l Epub ahead of print May 18, 2024. https://www.cghjournal.org/article

Synopsis

To determine whether immunosuppressive agents increase the risk of new or recurrent cancers among IBD patients with a prior history of malignancy, researchers at several tertiary care centers in the United States analyzed data from 305 IBD patients who previously had cancer. Patients were enrolled in the prospective SAPPHIRE registry, which began in 2016, and were followed annually for a median 4.8 years. None of the patients was receiving chemotherapy or radiation at the time of enrollment or had a recurrent cancer within the previous five years.

Almost half of the study participants were male and 88% were white. Patients were a median 32 years of age at the time of IBD diagnosis and a median 52 years of age at the time of index cancer diagnosis. The most common index cancers were solid organ (46%), dermatologic (32%), gastrointestinal (13%), and hematologic (9%).

During a median follow-up period of 4.8 years, 69% of patients received immunosuppressive therapy. These ranged from anti-tumor necrosis factor (TNF) agents to antimetabolites, including thiopurines and methotrexate, as well as other biologics.

Seventeen percent of patients receiving an immunosuppressant and 11% of those who did not receive an immunosuppressant developed an incident cancer during follow-up (p not significant). These included 25 new and 21 recurrent cancers.

Unadjusted analysis showed a cancer incidence of 2.58 per 100 person-years among patients unexposed to an immunosuppressive, compared to 4.78 per 100 person-years for exposed patients (Relative Risk [RR]: 1.85; 95% Confidence Interval [CI], 0.92–3.73).

An analysis adjusting for the effects of age, sex, history of smoking and stage at index malignancy, and excluding non-melanoma skin cancer found no significant association between exposure to immunosuppressive drugs and risk of incident cancer (adjusted Hazard Ratio: 1.41; 95% CI, 0.69–2.90). No other drug or major drug class carried a significant risk of incident cancer.

Details

Study Design: Prospective observational
Funding: The Crohn’s and Colitis Foundation, The Chemotherapy Foundation, New York Crohn’s and Colitis Organization and the Helmsley Charitable Trust.
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b