Biologics may lower risk of advanced-stage IBD-associated intestinal cancer

A recent nationwide study in The American Journal of Gastroenterology by Dr Ryo Seishima, M.D., Ph.D and team reports that biologic use linked with a lower risk of advanced Inflammatory Bowel Disease (IBD)-associated cancer in ulcerative colitis (UC) patients but not in Crohn's disease (CD) patients.

Over the last decade, biologics have gained an important place for the treatment of moderate to severe inflammatory bowel disease (IBD). Biologics are powerful drugs that are popularly known to slow or stop inflammation that can damage joints and organs in arthritis and other inflammatory diseases.

Current study evaluated the effect of biologics on the risk of advanced-stage IBD-associated intestinal cancer from a nationwide multicentre dataset. The medical records of CD and UC patients diagnosed with IBD-associated intestinal neoplasia (dysplasia or cancer) from 1983 to 2020 were included in this study. Therapeutic agents were classified into three types: biologics, 5-aminosalicylic acid (5-ASA), and immunomodulators (IMs). The pathological cancer stage was compared based on the drug used in both CD and UC patients.

The key findings of the study are

• A total of 1,042 patients (214 CD and 828 UC patients) were included. None of the drugs were significantly associated with cancer stage in the CD patients.

• In the UC patients, an advanced cancer stage was significantly associated with less use of biologics (early stage: 7.7% vs. advanced stage: 2.0%, P < 0.001), 5-ASA and IMs.

• Biologic use was associated with a lower incidence of advanced-stage cancer in patients diagnosed by regular surveillance (biologics [-] 24.5% vs. [+] 9.1%, P = 0.043), but this was not the case for the other drugs.

• Multivariate analysis showed that biologic use was significantly associated with a lower risk of advanced stage disease (odds ratio = 0.111 [95% CI, 0.034–0.356], P < 0.001).

Dr Ryo Seishima and team concluded that "Biologic use was associated with a lower risk of advanced IBD-associated cancer in UC patients but not in CD patients. The mechanism of cancer progression between UC and CD may be different and needs to be further investigated."

Reference: Seishima, Ryo M.D., Ph.D.; Okabayashi, Koji M.D.,a; Ikeuchi, Hiroki M.D., Ph.D.; Uchino, Motoi M.D., Ph.D.; Futami, Kitaro M.D., Ph.D.; Noguchi, Tatsuki M.D., Ph.D.; Ohge, Hiroki M.D., Ph.D.; Iseki, Yasuihito M.D., Ph.D. et al. "The effect of biologics on the risk of advanced-stage IBD-associated intestinal cancer: A nationwide study." The American Journal of Gastroenterology ; DOI: 10.14309/ajg.0000000000002149.