Clowry, Julianne and Sheridan, Juliette and Healy, R. and Deady, S. and Keegan, Denise and Byrne, K. and Cullen, Garret and Mulcahy, H. and Comber, Harry and Parnell, Andrew and Doherty, Glen and Lally, Aoife (2017) Increased non‐melanoma skin cancer risk in young patients with inflammatory bowel disease on immunomodulatory therapy: a retrospective single‐centre cohort study. Journal of the European Academy of Dermatology and Venereology, 31 (6). pp. 978-985. ISSN 0926-9959

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Abstract

Background Recent studies report an increased risk of non‐melanoma skin cancer (NMSC) in immunosuppressed patients with inflammatory bowel disease (IBD). Concurrently, paediatric IBD incidence is rising, with more patients now exposed to immunomodulators from a younger age. Objectives To investigate NMSC incidence and to examine the risk associated with immunomodulators in the development of NMSC in patients with IBD. Methods This was a retrospective single‐centre cohort study. Patients with IBD attending a tertiary adult hospital from 1994 to 2013 were included. Skin cancer incidence was compared with population data from the National Cancer Registry of Ireland (NCRI) to calculate standardized incidence ratio (SIR). Logistic regression was utilized for risk factor analysis. Results Two thousand and fifty‐three patients with IBD were studied. The SIR for NMSC in patients with IBD taking immunomodulators overall was 1.8 (95% CI: 1.0–2.7) with age‐specific rates significantly elevated across certain age categories. Exposure to thiopurines (OR: 5.26, 95% CI: 2.15–12.93, P < 0.001) and in particular thiopurines and/or tumour necrosis factor alpha (TNF‐α) inhibitors (OR: 6.45, 95% CI: 2.69–15.95, P < 0.001) was significantly associated with NMSC. The majority (82%) of those exposed to a TNF‐α inhibitor also had thiopurine exposure. Conclusions Compliance with skin cancer preventative measures should be highlighted to all patients with IBD. There should be a low threshold for dermatology referral for immunosuppressed patients, particularly those with a history of exposure to dual immunomodulators from a young age.

Item Type:	Article
Keywords:	Population; Thiopurines; Management; Metaanalysis; Monotherapy; Crohns-Disease; Combination Therapy; Azathioprine; Factor-I Receptor; Renal-Transplant Recipients; Dermatology; Inflammatory Bowel Diseases - drug therapy; Melanoma - epidemiology; Melanoma - complications; Humans; Adult; Female; Male; Retrospective Studies; Inflammatory Bowel Diseases - complications; Adjuvants; Immunologic - therapeutic use; Care and treatment; Cancer patients; Gastrointestinal diseases; Oncology; Experimental; Melanoma; Research; Health aspects; Risk factors; Skin cancer; Cancer;
Academic Unit:	Faculty of Science and Engineering > Mathematics and Statistics Faculty of Science and Engineering > Research Institutes > Hamilton Institute
Item ID:	11754
Identification Number:	https://doi.org/10.1111/jdv.14105
Depositing User:	Andrew Parnell
Date Deposited:	20 Nov 2019 14:35
Journal or Publication Title:	Journal of the European Academy of Dermatology and Venereology
Publisher:	Wiley
Refereed:	Yes
URI:	Publisher
Use Licence:	This item is available under a Creative Commons Attribution Non Commercial Share Alike Licence (CC BY-NC-SA). Details of this licence are available here

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