Original article—alimentary tractIncreased Risk for Non-Melanoma Skin Cancer in Patients With Inflammatory Bowel Disease
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
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2022, Gastroenterology Clinics of North AmericaCitation Excerpt :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.