John Kisiel, M.D., discusses a recently published article in Gastroenterology about the combination therapy of adalimumab and immunomodulators and the risk for cancer in patients with Crohn’s disease.
Recent studies have shown greater benefit when combining anti-TNF drugs with thiopurine drugs. Doctors have known for awhile that certain thiopurine drugs raise the risk of certain types of cancer, such as nonmelanoma skin cancers and lymphomas. It's important to know that the risk for cancer is small and the combination of drugs is the best strategy to treat Crohn's disease.
Dr. Osterman and his colleagues recently conducted a study of nearly 1,600 patients that were treated with adalimumab in clinical trails that led to the approval of that drug for ulcerative colitis and Crohn's disease. They measured the risk of cancer in a follow up, about a year and a half on average for each patient, and looked to see if patients were taking another immunosuppressant during the time they were on adalimumab. The researchers compared the rate of cancer in those patients with the general population using the SEER database, which measures the incidences of cancer throughout the United States for the general population.
The researchers found that roughly 34 of the 1,600 patients developed a cancer after participating in the study. That's roughly 2%. The risk of cancer was nearly three times higher in those taking the immunosuppressant with adalimumab compared to the general population. The risk of cancer in those patients taking adalimumab alone was not increased compared to the general population. Most of the cancers were nonmelanoma skin cancers. It was also interesting that the combination therapy had a higher risk of other cancers, such as breast and colon cancer.
It's important to remember that the combination therapy still has incredible benefits over using either drug alone.
The information in this new study is important for doctors and patients in terms of counseling about skin cancer and other cancers, including monitoring and prevention. Specifically, a patient should avoid suntanning, strictly avoid tanning beds, wear high SPF sunscreen, hats and long sleeves, and schedule an annual exam with a dermatologist.
Read the full study online here.
For more information about IBD, visit mayoclinic.org/ibd.
Dr. Kisiel is a gastroenterologist at Mayo Clinic.