Original article—alimentary tract
Increased Risk for Non-Melanoma Skin Cancer in Patients With Inflammatory Bowel Disease

https://doi.org/10.1016/j.cgh.2009.11.024Get rights and content

Background & Aims

Patients with inflammatory bowel disease (IBD) might be at increased risk for certain malignancies. We evaluated the risk of non-melanoma skin cancer (NMSC) in patients with IBD and determined how immunosuppressive and biologic medications affect this risk.

Methods

We performed retrospective cohort and nested case-control studies by using administrative data from PharMetrics Patient Centric Database. In the cohort study, 26,403 patients with Crohn's disease (CD) and 26,974 patients with ulcerative colitis (UC) were each matched to 3 non-IBD controls. NMSC risk was evaluated by incidence rate ratio (IRR). In the nested case-control study, 387 CD patients and 355 UC patients with NMSC were each matched to 4 IBD patients without NMSC by using incidence density sampling. Conditional logistic regression was used to determine the association between specific IBD medication use and NMSC.

Results

In the cohort study, the incidence of NMSC was higher among patients with IBD compared with controls (IRR, 1.64; 95% confidence interval [CI], 1.51–1.78). In the nested-case control study, recent thiopurine use (≤90 days) was associated with NMSC (adjusted odds ratio [OR], 3.56; 95% CI, 2.81–4.50), as was recent biologic use among patients with CD (adjusted OR, 2.07; 95% CI, 1.28–3.33). Persistent thiopurine use (>365 days) was associated with NMSC (adjusted OR, 4.27; 95% CI, 3.08–5.92), as was persistent biologic use among patients with CD (adjusted OR, 2.18; 95% CI, 1.07–4.46).

Conclusions

Patients with IBD, especially those who receive thiopurines, are at risk for NMSC. Appropriate counseling and monitoring of such patients with IBD are recommended.

Section snippets

Data Source

We analyzed the procedural and outpatient pharmaceutical insurance claims contained in the PharMetrics Patient-Centric Database (IMS Health, Watertown, MA) for the period August 1, 1996, through June 30, 2005. This longitudinal, patient-level database has been used in previous epidemiologic studies of IBD.10, 11 The included plans capture a geographically diverse sample. The number of plans per major U.S. census region (East, South, Midwest, West) ranges from 12 to 34, and the number of states

Cohort Study

The study population for the cohort study included 53,377 patients with IBD. Of these, 26,403 had CD, and 26,974 had UC. The median length of follow-up within this cohort was 730 days (interquartile range, 456–1004) for CD patients, 700 days (interquartile range, 456–988) for UC patients, and 1004 days (interquartile range, 730–1217) for controls. Characteristics of the patients with IBD were well-matched to their controls (Table 1).

For patients with IBD, the overall annual incidence rate of

Discussion

This study demonstrates that IBD patients have an increased risk of NMSC (IRR, 1.64; 95% CI, 1.51–1.78). This risk might be attributed in part to the underlying immune dysfunction of IBD, although the use of immunosuppressive medications appears to be a key driver as well. In particular, we observed that IBD patients with long-term use of thiopurines, other immunosuppressive agents, and patients with CD on anti-TNF medications or a combination of anti-TNF and immunosuppressive medications

References (27)

  • U. Leiter et al.

    Epidemiology of melanoma and nonmelanoma skin cancer: the role of sunlight

    Adv Exp Med Biol

    (2008)
  • B. Lindelof et al.

    Incidence of skin cancer in 5356 patients following organ transplantation

    Br J Dermatol

    (2000)
  • S. Euvrard et al.

    Skin cancers after organ transplantation

    N Engl J Med

    (2003)
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      It is reasonable to test for thiopurine S-methyltransferase (TPMT) and nudix hydrolase 15 (NUDT15) deficiency before initiating azathioprine or mercaptopurine, as patients with either deficiency are at increased risk for severe drug toxicity and may require decreased doses. Additional toxicities of these medications include bone marrow suppression, nonmelanoma skin cancers, and lymphoma.36–38 Immunomodulator monotherapy is less effective than biologic monotherapy or combination therapy of immunomodulator with a biologic in maintaining remission of disease.1,12

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    Conflicts of interest The authors disclose no conflicts.

    Funding The research was supported in part by grants from the NIH (T32 DK007634, 5-KL2-RR025746-02, P30 DK034987, R21 DK080408-01) and a senior research award from the Crohn's and Colitis Foundation of America.

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