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Evidence summaries

Lymphoma Risk Among Inflammatory Bowel Disease Patients Treated with Azathioprine or 6-Mercaptopurine

Inflammatory bowel disease patients who receive immunomodulator medications may be at higher risk of lymphoma than the general population. This increased risk could be due to the medication, disease activity, or both. Level of evidence: "C"

A systematic review 1 including 6 cohort studies with a total of 3891 subjects with inflammatory bowel disease (IBD; ulcerative colitis or Crohn's disease) was abstracted in DARE. The overall incidence of lymphoma (SIR 4.18, 95% CI 2.07 to 7.51, with a total of 11 cases of lymphoma) and the incidence of non-Hodgkin lymphoma (SIR 3.92, 95% CI 1.78 to 7.47, with a total of 9 cases of non-Hodgkin lymphoma) were increased among IBD patients compared with the general population. An increased risk of lymphoma was observed in IBD patients treated with azathioprine or 6-mercaptopurine compared to IBD patients who had not received this therapy (RR 2.92, 95% CI 1.05 to 8.13, 3 studies). The dosages of azathioprine ranged from 1.65 mg/kg per day to 106 mg/day for, and from 12.5 to 100 g/day for 6-MP. The mean duration of treatment was between 12.5 months and 4.4 years. It is not possible to fully exclude the possibility that the increased risk of lymphoma is associated with the severity of the disease, rather than being caused by the medications. Even if the increased risk is entirely attributable to the medications, it is unlikely to outweigh the potential benefits of these medications for most patients.

    References

    • Kandiel A, Fraser AG, Korelitz BI, Brensinger C, Lewis JD. Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine. Gut 2005 Aug;54(8):1121-5. [PubMed][DARE]

Primary/Secondary Keywords