Risk factors for malignancy and serious infection in patients with Inflammatory Bowel Disease: a retrospective analysis.

BACKGROUND: Patients with IBD patients are at increased risk of malignancy and infection compared to the general population.

AIMS: We aim to identify the risk factors for malignancy or serious infection in our IBD cohort.

METHODS: IBD patients at an adult tertiary referral centre were included. Demographic and clinical details including immunosuppressant exposure were collected and medical records were retrospectively screened for adverse events including malignancy or infection requiring hospitalisation. Logistic regression was used to evaluate risk factors for adverse events.

RESULTS: 549 patients with IBD [340 CD, 209 UC] were studied. Forty-eight malignancies, including 39 (81.3%) non-melanoma skin cancers (NMSC), 3 (6.3%) haematologic malignancies and 6 (15.4%) solid-organ malignancies were identified, and ninety-two cases of serious infection were detected. IBD disease duration (OR=1.08 95%CI:1.03-1.13) and ileocolonic Crohn's disease (OR=4.96 95%CI:1.13-21.71) were associated with increased odds of overall cancer. Compared with patients not previously exposed to the given class of immunosuppression assessed, the development of overall malignancy was not higher with thiopurine exposure (OR=1.00 95%CI:0.50-2.24) nor anti-TNF-alpha exposure (OR=0.78 95%CI:0.37-1.64).. Similarly, compared with patients not exposed, infection risk was not affected by thiopurine (OR=0.74 95%CI:0.46-1.20) nor anti-TNF exposure (OR=0.60 95%CI:0.38-0.95).

CONCLUSIONS: Factors including ileocolonic Crohn's disease and increasing IBD disease duration were associated with higher malignancy risk in this cohort. Compared with non-exposure, patients exposed to thiopurines were not at increased risk of malignancy or serious infection. Similarly, patients exposed to anti-TNF treatment did not experience increased rates of malignancy or serious infection compared to patients not exposed to this treatment. This article is protected by copyright. All rights reserved.