Increased Risk for Nonmelanoma Skin Cancers in Patients Who Receive Thiopurines for Inflammatory Bowel Disease

Peyrin–Biroulet, Laurent; Khosrotehrani, Kiarash; Carrat, Fabrice; Bouvier, Anne–Marie; Chevaux, Jean–Baptiste; Simon, Tabassome; Carbonnel, F.; Colombel, Jean–Frédéric; Dupas, Jean‐Louis; Godeberge, Philippe; Hugot, Jean‐Pierre; Lémann, Marc; Nahon, Stéphane; Sabaté, Jean‐Marc; Tucat, Gilbert; Beaugerie, Laurent

doi:10.1053/j.gastro.2011.06.050

Cited by 424 publications

(328 citation statements)

References 31 publications

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“…Further confi rmation in large prospective analyses is important to validate these initial observations. Th ere have been several studies that have highlighted an elevated risk of NMSC in patients with IBD ( 134,(138)(139)(140)(141)(142)(143)(144)(145)(146). It is recognized that individuals who use antimetabolite therapy with either azathioprine or 6-mercpatopurie whether current or prior use-escalates the risk of NMSC for users.…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

390

421

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

390

421

View full text Add to dashboard Cite

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“…The risk of cancer associated with methotrexate therapy has been assessed in patients with rheumatoid arthritis and most studies have not found an increased risk 22 In comparison, treatment with thio-purines increases the risk of lymphoma and nonmelanoma skin cancer. 3,[23][24][25] Nausea and vomiting were the most common minor adverse events associated with methotrexate therapy.…”

Section: Discussionmentioning

confidence: 99%

Methotrexate Is Not Superior to Placebo for Inducing Steroid-Free Remission, but Induces Steroid-Free Clinical Remission in a Larger Proportion of Patients With Ulcerative Colitis

et al. 2016

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“…Pese a esto, se debe tener presente los cambios fisiológicos en la biodisponibilidad de los esteroides 33 , ya que ellos pueden aumentar los eventos adversos en este grupo etario 34 . Junto con ello, es necesario considerar que la edad ha sido señalada como un factor de riesgo de linfoma y cáncer de piel no-melanoma en pacientes expuestos a fármacos inmunosupresores [35][36][37] , y de severas infecciones en pacientes que se encuentran con terapia inmunosupresora y biológica 37,38 . Cottone et al, señalaron que en pacientes > 60 años con EII tratados con terapia biológica, 11% desarrolló infecciones severas y 10% falleció, comparado con 2,6% y 1% respectivamente en pacientes > 60 años con EII sin tratamiento con terapia biológica 38 .…”

Section: Discussionunclassified