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P462. Influence of immunosuppressant treatment on the development and progression of neoplasms in patients with inflammatory bowel disease

G. Ontanilla Clavijo, E. Leo Carnerero, C. Trigo Salado, M.D. De La Cruz Ramirez, A. Araujo Miguez, J.M. Herrera Justiniano, J.L. Marquez Galan, HU Virgen del Rocío, UGC Digestive Diseases, Seville, Spain

Background

To understand the incidence of neoplasms of any type in patients with inflammatory bowel disease (IBD) as well as the relationship with immunomodulating and biological treatments on their risk and progression.

Methods

Retrospective analysis that includes 510 patients with IBD: 328 Crohn's disease (CD), 172 ulcerative colitis (UC) and 10 indeterminate colitis (IC), with the latter two considered as a single entity.

We collect demographic characteristics, tobacco and alcohol use, phenotypic characteristics of IBD, use of immunosuppressants (IS) (azathioprine (AZA), methotrexate (MTX), anti-TNF agents) in monotherapy or concomitantly.

Although we record all neoplasms that develop at any point in life, we perform the analysis on all those detected once the patient was diagnosed with IBD.

Results

The age at diagnosis of IBD was 31.3 years and the follow-up time was 9.69 years; 277 patients (54.3%) had been smokers at some time during their life, while excessive alcohol consumption was found in 37 (7.3%) patients.

In CD, use of some type of IS treatment was prescribed in 248/328 patients (76%), while in UC-IC group it was 68/182 (37.3%). In both cases, AZA was the most widely-used drug (242 CD and 65 UC-IC). MTX was used in 41 CD and 9 UC-IC, infliximab in 79 and 27 patients and adalimumab in 66 and 5, respectively. At least two concomitant IS agents were used in 111/510 patients (21.8%).

Five patients had neoplasm prior to IBD diagnosis. After IBD diagnosis, 23 neoplasms (4.5% of patients) were diagnosed. Among the factors analyzed, we only found alcohol to be a risk factor for the development of neoplasm (5/37 [13.5%] vs. 18/473 [3.8%], p = 0.02). Patients treated with an IS agent at any time developed neoplasms after the diagnosis of IBD in 12/316 (3.3%) vs. 11/194 (5.7%) of cases never treated with IS (p = 0.3) regardless of the type of IS used or whether combined therapy was used at any time (3/111 [2.7%]) or not (20/399 [5%]). When IS treatment was discontinued, IBD remained inactive in 2/7 cases while there was recurrence in the remaining 5 (one of whom required surgery) after a two-year follow-up period.

Nevertheless, the mean age at diagnosis of the neoplasm was lower in patients treated with IS (46.5 vs. 58 years, p = 0.06). After a mean follow-up of 3.13 years, mortality due to neoplasm in patients on IS treatment was 25% (3/12) vs. 9% (1/11) in patients who did not receive IS.

Conclusion

The use of IS drugs does not promote the development of neoplasms, even with combined therapy. However, when neoplasms do appear they are more aggressive since they occur at earlier ages and are associated with a higher short-term mortality rate due to the neoplasm.