Medically reviewed by Onikepe Adegbola, MD, PhD
Immunomodulator therapy, also known as, Thiopurine Therapy, is used to treat various diseases, including inflammatory bowel disease (IBDs). However, this treatment increases the risk of individuals with IBDs also getting diagnosed with cancer. Studies have shown that the longer the treatment through Thiopurine was, the higher the cancer risk. This study mainly comprised Caucasian patients from the west.
However, our particular research was carried out on Japanese patients with IBDs. The study was conducted to determine whether there was an increased risk of non-Hodgkin lymphoma (NHL), a specific type of cancer found in the lymphatic system of the immune system in patients with IBDs who were receiving Thiopurine therapy. We also assessed whether the dose and duration of this treatment would affect the risk of developing NHL as well. Lastly, age and IBD disease type in NHL were also investigated.
The study was conducted through a retrospective study of an extensive national administrative database provided by the Medical Data Vision (MDV). The data were checked for incidence rates of NHL cancer in individuals who were previously diagnosed with an IBD, such as Crohn’s disease and ulcerative colitis. It had to be such diagnosed patients who were receiving thiopurine therapy. These individuals also had to be ones that did not get the malignancy of cancer during diagnosis or after the first dose of the therapy.
The patients were also divided into subgroups of age and specific disease types to determine whether these factors impacted the malignancy risk.
Results of the Study
The results were astounding. The overall data found that there were about 76,673 patients who had been diagnosed with IBD. Out of all of these patients, nearly a hundred were diagnosed with NHL. This means that there is barely any link between thiopurine treatment and cancer. In other words, there was no risk of developing NHL in Japanese patients with IBD who received thiopurine therapy.
Additionally, the results also showed that the risk was not amplified and impacted by the frequency and type of dosage of this treatment. Therefore, this study showed that the duration and dose of thiopurine therapy for Japanese patients with IBDs do not have much of an impact on the development of NHL. The study shows no explanation for the increased risk of this cancer when one receives thiopurine therapy for IBDs. Lastly, age and specific disease did not have any noticeable effect on the development and risk of NHL either.
The impact of thiopurine therapy on IBDs is entirely different between Western and Japanese patients. Thus, perhaps genetics plays a significant role to play in increasing malignancy risk. However, the study did notice a lower incidence of NHL in people who received a longer duration of thiopurine therapy.
Note that since the data were extracted from the administrative claims database, there may be some confounding factors, such as errors in the coding of diagnosis and procedures, which could have impacted the overall results.
Kobayashi, T., Uda, A., Udagawa, E., & Hibi, T. (2020). Lack of Increased Risk of Lymphoma by Thiopurines or Biologics in Japanese Patients with Inflammatory Bowel Disease: A Large-Scale Administrative Database Analysis. Journal of Crohn’s & colitis, 14(5), 617–623. https://doi.org/10.1093/ecco-jcc/jjz204
Park, S. J., Kim, W. H., & Cheon, J. H. (2014). Clinical characteristics and treatment of inflammatory bowel disease: a comparison of Eastern and Western perspectives. World journal of gastroenterology, 20(33), 11525–11537. https://doi.org/10.3748/wjg.v20.i33.11525