Systematic review with meta‐analysis: thiopurines decrease the risk of colorectal neoplasia in patients with inflammatory bowel disease

Self Cite

mentioning

confidence: 53%

“…We thank Drs Laharie and Riviere for their interest in our work . As they mentioned, IBD is characterised by chronic recurrent intestinal inflammation, usually associated with increased risk of malignancies, especially gastro‐intestinal carcinomas.…”

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confidence: 92%

Editorial: weighing the global risk of cancer with thiopurines in inflammatory bowel disease—Authors' reply

Qiu

Zhang

2018

Self Cite

“…Recent work suggests that it is cumulative inflammatory burden which contributes to development of CRC, thus in theory any drug preventing inflammation might mediate this risk . Whether there are specific chemopreventive benefits for aminosalicylates is unclear . It has been hypothesised that aminosalicylates may specifically reduce colorectal dysplasia risk secondary to activation of peroxisome proliferator‐activated receptor‐γ, free radical scavenging, or inhibition of the Wnt/β‐catenin pathway .…”

Section: Discussionmentioning

confidence: 99%

“…66 Whether there are specific chemopreventive benefits for aminosalicylates is unclear. 67 It has been hypothesised that aminosalicylates may specifically reduce colorectal dysplasia risk secondary to activation of peroxisome proliferator-activated receptor-γ, 68 free radical scavenging, 69 or inhibition of the Wnt/β-catenin pathway. 70 Nevertheless, the low absolute risk of developing CRC in UC is unlikely to make use of aminosalicylates for chemoprevention a cost effective strategy, thus they are not recommended solely for cancer prevention in patients with UC.…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

Systematic review with meta‐analysis: high prevalence and cost of continued aminosalicylate use in patients with ulcerative colitis escalated to immunosuppressive and biological therapies

Guizzetti

Cipriano

et al. 2018

Summary Background Aminosalicylates are the most frequently prescribed treatment for ulcerative colitis (UC). In the absence of empirical evidence, clinicians are uncertain whether to continue aminosalicylates in patients with UC after escalating therapy. Aims To quantify concomitant aminosalicylate use in UC randomised clinical trials (RCTs), identify factors associated with their use, and estimate treatment costs of concomitant aminosalicylate therapy. Methods MEDLINE, Embase, and CENTRAL were searched from inception to 1 March 2017 for placebo‐controlled RCTs of immunosuppressants, biologics, or oral small molecules in adults with UC. The proportion of patients prescribed concomitant aminosalicylates at trial entry was pooled using a random‐effects model. Meta‐regression was performed to assess trial‐level factors associated with aminosalicylate use. Treatment costs were estimated using 2018 formulary data from five Canadian provinces. Results Thirty‐two trials were included (23 induction only, nine induction, and maintenance trials). The pooled proportion of patients co‐prescribed aminosalicylates was 80.7% (95% CI 75.5%‐85.1%), with considerable observed heterogeneity (I2 = 95%). In univariable meta‐regression, aminosalicylate use was not associated with trial design, setting, year of publication, disease severity, disease duration, or drug class. The estimated direct annual treatment cost of concomitant aminosalicylates is ~$20 million for the Canadian UC population, assuming conservative estimates of UC prevalence, aminosalicylate use and dose, and the lowest cost formulation. Conclusions Approximately 80% of UC patients entering clinical trials of immunosuppressants, biologics, or oral small molecules continue to use aminosalicylates. An RCT is needed to inform the benefits and harms of continuing vs stopping aminosalicylates in patients escalating therapy.

“…In the present updated meta-analysis including results from six additional studies and pooling data from 24 cohort, case-control and population-based studies, Lu et al observed an antineoplastic effect of thiopurine on high-grade dysplasia and colorectal cancer, especially in ulcerative colitis (UC). 8 In daily practice, despite the increase in IBD therapeutic armamentarium and safety signals on thiopurines, these conventional immunosuppressants remain often used. According to French national health insurance data collected from 2009 to 2013 among 210,001 patients, the 1-year cumulative probabilities for receiving thiopurine were 37.1% in CD and 15.2% in UC newly diagnosed.…”

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confidence: 99%

Editorial: weighing the global risk of cancer with thiopurines in inflammatory bowel disease

Laharie

Rivière

2018

Inflammatory bowel diseases (IBD) are associated with an increased risk of malignancy, which could be the consequence of the disease or its treatments. Therefore, it was expected that preventing gut inflammation with medical therapy could exert a preventive effect on this cancer risk.Two prior meta-analyses exploring the impact of thiopurines on the risk of colorectal neoplasia provided controversial conclusions. In the present updated meta-analysis including results from six additional studies and pooling data from 24 cohort, case-control and population-based studies, Lu et al observed an antineoplastic effect of thiopurine on high-grade dysplasia and colorectal cancer, especially in ulcerative colitis (UC). 2014-004728-23) will provide better knowledge on this personalised medicine for managing the whole cancer risk in IBD patients. ACKNOWLEDG EMENTS