Falk Gastro Info 9/2016

Video report

Immunsuppressive therapy in IBD patients with prior malignacy

Summary

In late April 2016 an international symposium was organized by the Falk Foundation in Prague entitled “Evolving Therapies in Clinical Practice in IBD”. The goal was to discuss current developments in this field and thus further enhance the medical treatment of patients with inflammatory bowel disease or abbreviated, IBD. Professor Jacques Cosnes, from Paris, spoke about the difficulties of immunosuppression treatment of IBD patients with a case history of malignant tumors.

Immunosuppressive medication increases the risk of certain cancers. Treatment with thiopurines in particular increases the likelihood of EBV-associated lymphoma and non-melanoma skin cancers, while treatment with TNF-α inhibitors increases the danger of a malignant melanoma. However, the risk of a colorectal carcinoma falls. But what impact does that have on treating patients with a case history of malignant tumors? A recent study based on follow-up data from more than 30,000 patient-years showed no increased risk of new or relapsing carcinoma for patients with prior malignancy receiving monotherapy with immunosuppressants¹. Without immunosuppressive therapy the rate stood at 37.5 cases per 1000 patient-years while with an immunomodulator it was 36.2 and with TNF-α blockers it was 33.8 cases. An increase to 54.5 cases was observed under combination therapy. Patients with a history of carcinoma can be treated with immunosuppressants under the following conditions: before beginning treatment, a residual or latent carcinoma should be ruled out. At least 2 to 5 years should elapse between developing cancer and beginning treatment. The choice of immunosuppressant should take account of the sort of tumor the patient had.

More specifically that means: No azathioprine or 6-MP for patients who had EBV- or HPV-associated tumors or a carcinoma in the urogenital tract. No TNF-α inhibitors for patients who had a malignant melanoma and no vedolizumab for those who had a gastrointestinal carcinoma.

Shelton E et al. Gastroenterology. 2016;151(1):97–109.e4.

Video-Report presented by: Professor Dr. Jaques Cosnes, Hôpital Saint Antoine, Paris, France at the Symposium 202 „Evolving Therapies in Clinical Practice in IBD“, April 29–30, 2016 in Prague.

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Latest research in brief:

Bowel

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Julsgaard M et al, Gastroenterology. 2016;151(1):110–9

TNF inhibitor therapy during pregnancy: Drugs in newborns can be detected for up to 12 months. The risk of infectious complications is particulary increased following combination therapy with TNF inhibitors and thiopurines.

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Wouters MM et al, Gut. 2016;65(8):1279–88

Postinfectious irritable bowel syndrome (PI-IBS): Psychological comorbidity increases the risk for PI-IBS partly by enhanced susceptibility to develop infectious gastroenteritis.

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Chan FKL et al, Gastroenterology. 2016;151(2):271–7

Aspirin and lower gastrointestinal hemorrhage: Continued therapy with aspirin correlates with increased risk of bleeding recurrence, but reduces the risk of major cardiovascular events and death.

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Liver Biliary Tracts

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Hirschfield GM et al, Hepatology. 2016;64(1):189–99

Primary biliary cholangitis (PBC): 20 weeks of treatment with the monoclonal anti-IL12/23 antibody ustekinumab did not lead to an appreciably change of alkaline phosphatase and fibrosis score in patients with primary biliary cholangitis and inadequate response to ursodeoxycholic acid.

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Huang F et al, Hepatology. 2016;64(2):350–9

Hepatitis E: A current study from China suggests that cows may be an important zoonotic source of hepatitis E virus. Even pasteurized milk remained infectious. Future studies need to clarify whether these results obtained for hepatitis E virus genotype 4 are also relevant in Europe and North America.

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Cui J et al, J Hepatol. 2016;65(2):369–76

Non-alcoholic fatty liver disease (NAFLD): In contrast to the promising results of previous uncontrolled studies, a current randomized, double-blind, placebo-controlled trial could not demonstrate a reduction of liver fat during a 24-week course of sitagliptin in patients with NAFLD and prediabetes or early diabetes.

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