Cancer Risk Great in Crohn’s Disease Patients Treated with Combination Drug Therapy – IBD News

John Kisiel, M.D., a gastroenterologist at Mayo Clinic, discusses a recently published article in Gastroenterology about the combination therapy of adalimumab and immunomodulators and the risk for nonmelanoma skin cancer and other cancers in patients with Crohn’s disease.

Hello my name is john kissel and i’m a gastroenterologist specializing in the treatment of inflammatory bowel disease at mayo clinic in rochester minnesota i’ve been given the opportunity to talk today about a recent publication in the journal gastroenterology which shows an increase in the risk of malignancy or cancer with the combination of a dilemma mab also

Known as humira with other immunosuppressant medications and that risk is shown over just using a dilemma map alone recent studies have shown that we get greater benefit when we use a strategy that combines anti-tnf or anti tumor necrosis factor-alpha drugs such as infliximab or remicade with other immunosuppressants specifically thiopurine drugs such as a’s athiya

Preneur m urine and 6 mp so increasingly doctors have been using this strategy with other anti-tnf drugs such as a dilemma map even though a study showing combination immunosuppression with a dilemma map and other immunosuppressants has not yet been conducted we’ve known for a while that the thiopurine drugs raise the risk of certain types of cancer especially

Non-melanoma skin cancers and lymphomas we’ve assumed that combining the medications with the anti-tnf drugs probably incrementally raises that risk even further it’s important to understand that the risks of cancer are still very small and that the combination of the drugs is probably the best strategy that we have for treating crohn’s disease however patients and

Their doctors are eager to understand if there’s any new information measuring that risk in order to better counsel in their the medication use dr. osterman and his colleagues recently conducted a study of over 60 or nearly 1,600 patients that were treated with a dilemma map or humira in the clinical trials that led to the approval of that drug for ulcerative colitis

And crohn’s disease they measured the risk of cancer in follow-up about a year and a half on average for each patient that participated in the study and they looked to see whether or not any of those patience were taking another immunosuppressant at the time that they were on the a dilemma map or humira they then compared the rates of cancer in those patients with

The general population using the seer database which measures the incidence of cancer throughout the united states for the general population what they found was that of those 16 hundred patients roughly 34 developed a cancer after participating in the study that’s about 2% but the risk of cancer was nearly 3 times higher and those that were taking the combination

Of the immunosuppression with the a dilemma map compared to the general population and the risk of cancer in those taking adalimumab alone was not increased in comparison to the general population most of these cancers were non-melanoma skin cancers that includes basal cell and squamous cell cancer but it was also interesting that the combination immunosuppression

Group had higher rates of other cancers such as breast and colon cancer it’s important to remember that the combination of these drugs while it raises the risk of cancer still has incredible benefit over using either drug alone and to kind of estimate that risk the authors of this paper included in their discussion some back of the napkin calculations if we infer

The cancer rate and the benefit that we would see with combination therapy from the studies that we’ve used we’ve studied with infliximab in combination with ease of thio print it would take only about one extra patient in 9 treated with the combination of the drugs to benefit over being treated with either drug alone and in contrast nearly one in a hundred and

Seventy patients would get harmed from that combination strategy this information in this new study is important for patients and their doctors in terms of counseling about skin cancer and other cancers monitoring and prevention specifically patients should probably avoid sun tanning they should strictly avoid tanning beds they should wear high spf sunscreen and

Long hats long sleeves rather hats and long sleeves and they should probably be getting an annual examination by dermatologists to monitor for skin cancer thank you very much for your time

Transcribed from video
Cancer Risk Great in Crohn's Disease Patients Treated with Combination Drug Therapy – IBD News By Mayo Clinic