Biologics for Ulcerative Colitis May Decrease Risk for Advanced-Stage Cancer

Receiving treatment with biologics is associated with reduced risk for advanced inflammatory bowel disease (IBD)-associated intestinal cancer in patients with ulcerative colitis (UC), but not Crohn disease (CD), according to study findings published in the American Journal of Gastroenterology.

Researchers conducted a nationwide, multicenter, retrospective study on 1042 patients — 214 with CD and 828 with UC — who received a diagnosis of IBD-associated intestinal neoplasia. Researchers analyzed the effect of biologics as well as other pharmaceutical interventions used to treat IBD on the risk for advanced-stage IBD-associated intestinal cancer.

Therapeutic agents given to patients with IBD were categorized into 3 categories: biologics, immunomodulators, and 5-aminosalicyclic acids (5-ASA). In particular, biologics that were studied included vedolizumab, infliximab, golimumab, and adalimumab.

Each institution implemented its own criteria for the surveillance, diagnosis, and grading of IBD-associated intestinal neoplasia (or dysplasia). Early-stage cancer was defined as either dysplasia or pathological stage 0/I cancer, whereas advanced-stage cancer was defined as pathological stage II/III/IV cancer.

Advanced-stage IBD-associated intestinal cancer occurred in 159 of the 214 (74.3%) patients with CD and 297 of the 828 (35.9%) patients with UC. The remaining patients in each group were diagnosed with early-stage cancer.

Compared with early-stage cancer, advanced-stage cancer was diagnosed less frequently using regular surveillance methods (38.2% vs 20.1%; P =.007). Additionally, compared with early-stage cancer, those with advanced-stage cancer had less differentiated adenocarcinoma (56.4% vs 19.5%; P <.001). Researchers found no significant difference between the use of the 3 different therapeutic agents on cancer stage.

Among patients diagnosed using regular surveillance methods, biologics were associated with decreased frequency of advanced-stage cancer diagnosis (biologics: (-) 24.5% vs (+) 9.1%; P =.043), but immunomodulators and 5-ASA agents demonstrated no significant association.

In contrast, all 3 types of medications reduced the frequency of advanced-stage cancer in patients diagnosed using methods other than regular surveillance (biologics: (-) 66.1% vs (+) 21.4%; P =.001, 5-ASA: (-) 80.0% vs (+) 57.4%; P =.001; immunomodulators: (-) 67.5% vs (+) 28.0%; P <.001).

In patients with UC, both biologic (odds ratio [OR], 0.111; 95% CI, 0.034-0.356; P <.001) and 5-ASA (OR, 0.628; 95% CI, 0.401-0.982; P =.041) use was associated with decreased risk for advanced-IBD-associated cancer. However, the reduced risk associated with these interventions was not observed in patients with CD.

“[B]iologic use was associated with a lower risk of advanced IBD-associated cancer in patients with UC, although this association was not significant in patients with CD,” the study authors wrote. “As the effect of drugs for IBD on cancer progression has not been widely discussed, the results of this study will lay a foundation for further investigations.”

Study limitations include lack of data on quantity of drugs used and duration of use, the lack of implementation of standardized diagnostic criteria and surveillance methods for IBD-associated intestinal neoplasia across the 43 institutions included in the study, and the relatively low overall rate of biologic use in this study.