P432 Do tumor necrosis factor alpha antagonists reduce the development of advanced colonic neoplasia?
D.Y. Oh*1, J.Y. Lee2, S.-J. Koh1, H. Yoon3, Y.S. Park3, H.W. Kang4, J.P. Im2, J.W. Kim1, B.G. Kim1, J.S. Kim2, K.L. Lee1
1Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea, Republic of, 2Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea, Republic of, 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea, Republic of, 4Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea, Republic of
The aim of this study was to evaluate the effect tumor necrosis factor (TNF)-alpha antagonist on the development of advanced colonic neoplasia.
Our study consisted of 67 patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriasis who used TNF-alpha antagonists and underwent colonoscopies after initial diagnosis. For each patient who used TNF-alpha antagonists, four age- (±5 years) and sex- matched controls were identified from patients with RA, AS, or psoriasis. We compared the prevalence of advanced colonic neoplasia between the two groups. Factors associated with advanced colonic neoplasia were analyzed.
A total of 67 patients and 268 age-and gender-matched controls were identified. Etanercept was used in 47 patients (70.1%), infliximab in 8 patients (11.9%), and adalimumab in 12 patients (17.9%), respectively. Median duration of TNF-alpha antagonists' use was 23.7 ± 19.95 months. Two patients (3.0%) had advanced colonic neoplasia, including one colon cancer (1.5%) in TNF-alpha antagonists group. In contrast, 29 patients (10.8%) were diagnosed with advanced colonic neoplasia, including 10 (3.7%) colon cancers and 21 (7.8%) advanced adenomas in the control group. A case-control study revealed that the odds of detecting an advanced neoplasia among patients who used TNF-alpha antagonists were one fourth of the age- and sex- matched controls [OR, 0.254; 95% CI, 0.059 to 1.091; P = 0.048]. The use of TNF-alpha antagonists antagonist was an independent preventive factor for advanced colonic neoplasia (OR 0.20; 95% CI, 0.04 to 0.95, P = 0.043)
Further study is needed to demonstrate the chemopreventive effect of TNF-alpha antagonists in patients with inflammatory bowel disease.