Aggressive therapy in pediatric IBD patients linked to mortality, cancer

Mortality and malignancy, the most serious complications of pediatric inflammatory bowel disease, were relatively rare and linked most commonly with aggressive treatment rather than the condition itself, according to recent study data.

In a multinational retrospective study, researchers surveyed all pediatric gastroenterologists in 20 European countries and Israel on cancer and/or mortality among their pediatric patients with inflammatory bowel disease (PIBD) from 2006 to 2011.

Among 44 children diagnosed with IBD (median age at diagnosis, 10 years; 26 boys), 18 cases of cancer were identified and/or 31 patients died. Twelve cancer patients had Crohn’s disease, and 19 patients who died had ulcerative colitis (UC). The most common cancers were hematopoietic tumors (n=11). Mortality was attributed to infections (n=14) and other causes, including cancer (n=5), uncontrollable disease activity related to IBD (n=4) and procedural complications (n=3).

“Cancer and mortality in PIBD are rare, but cumulative rates are not insignificant,” the researchers wrote. “Mortality is primarily related to infections, particularly in patients with two or more immunosuppressive agents, followed by cancer and uncontrolled disease. At least six lymphomas were likely treatment-associated by virtue of their phenotype.”

Researchers said that aggressive therapy with immunosuppressants and biologics has become common among PIBD patients because their disease is often more severe than that found in adults with IBD. As a result, concern has grown that overly aggressive treatment may increase the risk for malignancy and mortality.

“It is striking that the majority of patients [who died] were diagnosed with UC, although UC is considered to be curable by colectomy,” the researchers said. “Nine out of 19 patients with UC died because of an infectious complication. These fatalities may have been prevented by earlier surgical intervention when intensified medical treatment is ineffective.”

The researchers called for larger-scale prospective studies on “the complex problem of the very rare but severe outcomes of PIBD.”

Disclosure: The researchers report no relevant financial disclosures.