Colon to Rectum
Clin Gastroenterol Hepatol. 2023;21(6):1598–606.e5
Comparative safety of biologic agents in patients with inflammatory bowel disease with active or recent malignancy: A multicenter cohort study
Background and aims: Safety of biologic agents is a key consideration in patients with inflammatory bowel disease (IBD) and active or recent cancer. The authors compared the safety of tumor necrosis factor (TNF)α antagonists versus non-TNF biologics in patients with IBD with active or recent cancer.
Methods: They conducted a multicenter retrospective cohort study of patients with IBD and either active cancer (cohort A) or recent prior cancer (within ≤ 5 years; cohort B) who were treated with TNFα antagonists or non-TNF biologics after their cancer diagnosis. Primary outcomes were progression-free survival (cohort A) or recurrence-free survival (cohort B). Safety was compared using inverse probability of treatment weighting with propensity scores.
Results: In cohort A, of 125 patients (483.8 person-years [PYs] of follow-up evaluation) with active cancer (age, 54 ± 15 years, 75% solid-organ malignancy), 10 of 55 (incidence rate [IR] per 100 PYs, 4.4) and 9 of 40 (IR, 10.4) patients treated with TNFα antagonists and non-TNF biologics had cancer progression, respectively. There was no difference in the risk of progression-free survival between TNFα antagonists versus non-TNF biologics (hazard ratio [HR] = 0.76; 95% confidence interval [CI]: 0.25–2.30). In cohort B, of 170 patients (513 PYs of follow-up evaluation) with recent prior cancer (age, 53 ± 15 years, 84% solid-organ malignancy; duration of remission, 19 ± 19 months), 8 of 78 (IR, 3.4) and 5 of 66 (IR, 3.7) patients treated with TNFα antagonists and non-TNF biologics had cancer recurrence, respectively. The risk of recurrence-free survival was similar between both groups (HR = 0.94; 95% CI: 0.24–3.77).
Conclusions: In patients with inflammatory bowel disease (IBD) with active or recent cancer, tumor necrosis factor (TNF)α antagonists and non-TNF biologics have comparable safety. The choice of biologic should be dictated by IBD disease severity in collaboration with an oncologist.