Certain IBD immunosuppressives increased risk for skin cancer
Patients with IBD treated with biologics were at an increased risk for developing melanoma, and those receiving thiopurines were more likely to develop nonmelanoma skin cancer in a recent study.
Researchers evaluated data on 108,579 patients with IBD, along with 434,233 matched controls, with a median follow-up of 24 months. The cohort included 50,920 patients with Crohn’s disease (CD) and 56,390 with ulcerative colitis (UC), as well as 1,269 patients with an unknown IBD. In additional nested case-control studies, investigators matched 209 patients with IBD and melanoma with 823 controls without melanoma, and 3,288 patients with nonmelanoma skin cancer (NMSC) and IBD with 12,945 controls without NMSC.
Patients with IBD had an increased risk for melanoma (RR=1.29; 95% CI, 1.09-1.53), particularly among patients with CD (RR=1.45; 95% CI, 1.13-1.85). This association for the overall IBD cohort was not found significant after adjusting for comorbidities and health care utilization (adjusted HR=1.15; 95% CI, 0.97-1.36), but patients with CD still were found at increased risk (adjusted HR=1.28; 95% CI, 1.00-1.64).
NMSC was more common among those with IBD (RR=1.46; 95% CI, 1.40-1.53). Patients with CD (RR=1.64; 95% CI, 1.54-1.74), and those with UC (RR=1.34; 95% CI, 1.26-1.42) were at increased risk for NMSC. Results were similar after adjusting for comorbidities and health care utilization among patients with CD (HR=1.48; 95% CI, 1.39-1.58) and UC (HR=1.23; 95% CI, 1.16-.131).
The nested case-control studies indicated that biologic therapy for IBD increased patients’ risk for melanoma (adjusted OR=1.88; 95% CI, 1.08-3.29, while patients receiving thiopurines were at higher risk for NMSC (adjusted OR=1.85; 95% CI, 1.66-2.05). Long-term use of biologics increased the risk for melanoma (adjusted OR=3.93; 95% CI, 1.82-8.50 vs. nonlong-term use), while NMSC risk was increased by long-term use of thiopurines and biologics in combination (adjusted OR=3.89; 95% CI, 2.33-6.46).
Millie D. Long
“While there is a slightly increased relative risk for melanoma associated with biologic anti-TNF therapy, the absolute risk remains very low,” researcher Millie D. Long, MD, MPH, assistant professor of medicine in the gastroenterology and hepatology division at the University of North Carolina, Chapel Hill, told Healio.com. “These data, along with data on the increased risk of nonmelanoma skin cancer associated with various forms of immunosuppression in IBD patients, support the role for preventive measures such as sunscreen use and skin examinations.”