Risk of cancer recurrence in patients with immune-mediated diseases with use of immunosuppressive therapies: An updated systematic review and meta-analysis

Background and aims: There are limited data on the safety of immunosuppressive therapy use in individuals with immune-mediated diseases with a history of malignancy, particularly with newer biologic and small-molecule treatments.
Methods: The authors performed a systematic search of PubMed and Embase databases to identify studies examining the impact of immunosuppressive therapies on cancer recurrence across several immune-mediated diseases. Studies were pooled together using random-effects meta-analysis and stratified by type of treatment. Primary outcome was occurrence of incident cancers, defined as new or recurrent.
Results: The meta-analysis included 31 studies (17 inflammatory bowel disease, 14 rheumatoid arthritis, 2 psoriasis, and 1 ankylosing spondylitis) contributing 24,328 persons and 85,784 person-years (PY) of follow-up evaluation. Rates of cancer recurrence were similar among individuals not on immunosuppression (1627 incident cancers, 43,765 PY; 35 per 1000 PY; 95% confidence interval [CI]: 27–43), receiving an anti-tumor necrosis factor (571 incident cancers, 17,772 PY; 32 per 1000 PY; 95% CI: 25–38), immunomodulators (1104 incident cancers, 17,018 PY; 46 per 1000 PY; 95% CI: 31–61), combination immunosuppression (179 incident cancers, 2659 PY; 56 per 1000 PY; 95% CI: 31–81). Patients receiving ustekinumab (5 incident cancers, 213 PY; 21 per 1000 PY; 95% CI: 0–44) and vedolizumab (37 incident cancers, 1951 PY; 16 per 1000 PY; 95% CI: 5–26) had numerically lower rates of cancer. There were no studies on Janus kinase inhibitors. Stratification of studies by timing of immunosuppression initiation did not reveal a medication effect based on early (< 5 years) or delayed treatment initiation.

Conclusions: In patients with immune-mediated diseases and a history of malignancy, similar rates of cancer recurrence were observed in those on no immunosuppression compared with different immunosuppressive treatments.

A.N. Ananthakrishnan, M.D., Associate Professor of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, E-Mail: aananthakrishnan@mgh.harvard.edu

DOI: 10.1016/j.cgh.2023.07.027

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