Curbside Consultation in IBD: 49 Clinical Questions, Second Edition

David T Rubin, MD; Sonia Friedman, MD; Francis A Farraye, MD MSc

Question 31: My Patient Has A History Of Breast Cancer And Is In Remission From That Condition. She Also Has Crohn’S Disease. Can I Use Azathioprine Or Infliximab To Treat Her? What If There Is A Family History Of Lymphoma Or Leukemia? Should That Influence Management? (continued)

Remo Panaccione, MD

The use of immunosuppressants, such as purine antimetabolites (azathioprine [AZA], 6-mercaptopurine [6-MP], and methotrexate [MTX]) and anti-tumor necrosis factor (TNF) agents (infliximab, adalimumab, and certolizumab pegol), in patients with a history of solid organ malignancy and hematological malignancies is a common question that raises some controversy. Both purine antimetabolites and MTX have been associated with the development of solid organ malignancies. However, one needs to look at the literature in a critical fashion before assuming this association is a contraindication for using…