Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study Export

@article{citeulike:5976440, abstract = {Summary Background Reports of an increased risk of lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease are controversial. We assessed this risk in a prospective observational cohort study. Methods 19 486 patients with inflammatory bowel disease, of whom 11 759 (60·3\%) had Crohn's disease and 7727 (39·7\%) had ulcerative colitis or unclassified inflammatory bowel disease, were enrolled in a nationwide French cohort by 680 gastroenterologists, who reported details of immunosuppressive therapy during the observation period, cases of cancer, and deaths. The risk of lymphoproliferative disorder was assessed according to thiopurine exposure. Median follow-up was 35 months (IQR 29–40). Findings At baseline, 5867 (30·1\%) of patients were receiving, 2809 (14·4\%) had discontinued, and 10 810 (55·5\%) had never received thiopurines. 23 new cases of lymphoproliferative disorder were diagnosed, consisting of one case of Hodgkin's lymphoma and 22 cases of non-Hodgkin lymphoproliferative disorder. The incidence rates of lymphoproliferative disorder were 0·90 per 1000 (95\% CI 0·50–1·49) patient-years in those receiving, 0·20/1000 (0·02–0·72) patient-years in those who had discontinued, and 0·26/1000 (0·10–0·57) patient-years in those who had never received thiopurines (p=0·0054). The multivariate-adjusted hazard ratio of lymphoproliferative disorder between patients receiving thiopurines and those who had never received the drugs was 5·28 (2·01–13·9, p=0·0007). Most cases associated with thiopurine exposure matched the pathological range of post-transplant disease. Interpretation Patients receiving thiopurines for inflammatory bowel disease have an increased risk of developing lymphoproliferative disorders.}, author = {Beaugerie, Laurent and Brousse, Nicole and Bouvier, Anne M. and Colombel, Jean F. and L\'{e}mann, Marc and Cosnes, Jacques and H\'{e}buterne, Xavier and Cortot, Antoine and Bouhnik, Yoram and Gendre, Jean P.}, citeulike-article-id = {5976440}, citeulike-linkout-0 = {http://dx.doi.org/10.1016/S0140-6736(09)61302-7}, citeulike-linkout-1 = {http://linkinghub.elsevier.com/retrieve/pii/S0140673609613027}, day = {16}, doi = {10.1016/S0140-6736(09)61302-7}, issn = {01406736}, journal = {The Lancet}, keywords = {ibd}, month = {October}, posted-at = {2009-10-20 20:54:20}, priority = {2}, title = {Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study}, url = {http://dx.doi.org/10.1016/S0140-6736(09)61302-7}, year = {2009} }

TY - JOUR ID - citeulike:5976440 L3 - citeulike-article-id:5976440 N2 - Summary Background Reports of an increased risk of lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease are controversial. We assessed this risk in a prospective observational cohort study. Methods 19 486 patients with inflammatory bowel disease, of whom 11 759 (60·3%) had Crohn's disease and 7727 (39·7%) had ulcerative colitis or unclassified inflammatory bowel disease, were enrolled in a nationwide French cohort by 680 gastroenterologists, who reported details of immunosuppressive therapy during the observation period, cases of cancer, and deaths. The risk of lymphoproliferative disorder was assessed according to thiopurine exposure. Median follow-up was 35 months (IQR 29–40). Findings At baseline, 5867 (30·1%) of patients were receiving, 2809 (14·4%) had discontinued, and 10 810 (55·5%) had never received thiopurines. 23 new cases of lymphoproliferative disorder were diagnosed, consisting of one case of Hodgkin's lymphoma and 22 cases of non-Hodgkin lymphoproliferative disorder. The incidence rates of lymphoproliferative disorder were 0·90 per 1000 (95% CI 0·50–1·49) patient-years in those receiving, 0·20/1000 (0·02–0·72) patient-years in those who had discontinued, and 0·26/1000 (0·10–0·57) patient-years in those who had never received thiopurines (p=0·0054). The multivariate-adjusted hazard ratio of lymphoproliferative disorder between patients receiving thiopurines and those who had never received the drugs was 5·28 (2·01–13·9, p=0·0007). Most cases associated with thiopurine exposure matched the pathological range of post-transplant disease. Interpretation Patients receiving thiopurines for inflammatory bowel disease have an increased risk of developing lymphoproliferative disorders. JF - The Lancet SN - 01406736 TI - Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study KW - ibd AU - Beaugerie, Laurent AU - Brousse, Nicole AU - Bouvier, Anne AU - Colombel, Jean AU - Lémann, Marc AU - Cosnes, Jacques AU - Hébuterne, Xavier AU - Cortot, Antoine AU - Bouhnik, Yoram AU - Gendre, Jean PY - 2009/10/16/ UR - http://dx.doi.org/10.1016/S0140-6736(09)61302-7 ER -