Thiopurine therapy increases the risk of nonmelanoma skin cancers (NMSCs) in organ transplant patients. The data on NMSC in patients with IBD on thiopurines is conflicting. METHODS: We searched electronic databases for full journal articles reporting on the risk of developing NMSC in patients with IBD on thiopurine and hand searched the reference lists of all retrieved articles. Pooled adjusted hazard ratios and 95% confidence intervals (CIs) were determined using a random-effects model. Publication bias was assessed using Funnel plots and Egger’s test. Heterogeneity was assessed using Cochran’s Q and the I2 statistic. RESULTS: Eight studies involving 60,351 patients provided data on the risk of developing NMSC in patients with IBD on thiopurines. The pooled adjusted hazards ratio of developing NMSC after exposure to thiopurines in patients with IBD was 2.28 (95% CI: 1.50 to 3.45). There was significant heterogeneity (I2=76%) between the studies but no evidence of publication bias. Meta regression analysis suggested that the population studied (hospital-based vs. population-based) and duration of follow-up contributed significantly to heterogeneity. Grouping studies based on population studied and duration showed higher hazard rations in hospital-based and shorter duration studies. CONCLUSIONS: The risk of developing NMSC in patients with IBD on thiopurines is only modestly elevated.
Drugs cut need for surgery for Crohn’s disease sufferers by more than half
Crohn’s affects more than quarter-of-a-million people in the UK leading to an inflamed intestine. Researchers from St George’s, University of London, St George’s Hospital, London and Imperial College, London, monitored more than 5,000 patients in the UK living with Crohn’s disease for more than 20 years and looked at the effect of thiopurine drugs that suppress inflammation in the gut. Gastroenterologist Dr Richard Pollok, an honorary senior lecturer at St George’s, University of London, said “Our discovery is timely since new guidelines from the USA have played down the benefits of these drugs in favour of newer agents. “A year of treatment with the newer ‘biologics’, which are administered by injection, cost about 10,000 more compared to thiopurines. “We try to avoid surgery but some patients face multiple procedures because the disease can flare up again particularly where the intestine has been rejoined. “The fact that thiopurines can cut the need for surgical intervention and remain affordable is good news for patients and the NHS.” They found patients taking thiopurines, such as Azathioprine, for more than 12 months had a 60% reduction within the first 5 years of diagnosis. Thiopurines have been used in the treatment of inflammatory bowel conditions like Crohn’s disease since the 1970s but their long-term benefits have just come to light. There has been a major increase in the number of patients who receive these drugs in the past decade and rates of surgery in patients with this condition have dropped, partly as a result of these and other treatments. But up to a quarter of patients still go on to have their first corrective surgery to remove the worst affected areas within 5 years of being diagnosed. The study, published in the American Journal of Gastroenterology, was funded by the National Institute for Health Research. More information: Chatu S, Saxena S, Subramanian V, Curcin V, Yadegarfar G, Gunn L, Majeed A, Pollok R.C. The Impact of Timing and Duration of Thiopurine Treatment on First Intestinal Resection in Crohn ‘ s Disease: National UK Population-Based Study 1989 2010 Am J Gastroenterol 28 Jan 2013; DOI: 10.1038/ajg.2013.462 Provided by St.
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