Åsa H Everhov, Johan Askling, Jonas Söderling, Jonas Halfvarson, Julia Eriksson, Karin E Smedby, Jonas F Ludvigsson, Henrik Toft Sørensen, Ola Olén
{"title":"溃疡性结肠炎Naïve患者接受或接受硫嘌呤和靶向治疗的癌症发病率——2007年至2022年的一项队列研究，与普通人群进行比较","authors":"Åsa H Everhov, Johan Askling, Jonas Söderling, Jonas Halfvarson, Julia Eriksson, Karin E Smedby, Jonas F Ludvigsson, Henrik Toft Sørensen, Ola Olén","doi":"10.1093/ecco-jcc/jjaf091","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cancer incidence data including absolute risk differences are needed for clinical risk communication to patients receiving modern-day treatments for ulcerative colitis (UC).</p><p><strong>Methods: </strong>We linked nationwide Swedish health registers and assessed incident cancers in patients with UC in 2007-2022. We computed age-stratified incidence rates (IRs), IR differences, and hazard ratios (HRs) in a naïve cohort with no immunomodulatory treatment, and in cohorts treated with thiopurine or targeted therapies. General population comparator subjects were matched (by age, sex, calendar year, and area of residence) to each treatment cohort. We used a once-exposed-always-exposed design.</p><p><strong>Results: </strong>We identified 63 925 patients with UC in partly overlapping cohorts and 593 072 comparators with a total follow-up time of 5 800 089 years (median 8.1 years). The IRs were elevated compared to the general population in naïve patients: 2.7 extra cancer cases per 1000 person-years (HR: 1.12, 95% CI, 1.09-1.16), in thiopurine-treated patients: 3.4 extra cases (HR: 1.48;1.37-1.61), tumor necrosis factor inhibitor (TNFi)-treated: 2.7 extra cases (HR: 1.41;1.24-1.62), Thiopurine + TNFi-treated: 2.42 extra cases (HR: 1.44;1.19-1.75), vedolizumab-treated: 2.88 extra cases (HR: 1.27;0.90-1.79). The IR differences were not significantly increased in patients treated with ustekinumab 0.57 (HR: 0.87;0,39-1.93) and tofacitinib -0.69 (HR: 0.84;0.25-2.77). Across all treatment groups, the IR differences compared to the general population were highest in patients ≥ 60 years. The differences were driven by colorectal cancer, hepatobiliary cancer, lymphoma, and basal cell skin carcinoma.</p><p><strong>Conclusions: </strong>Elevated cancer incidence was observed in patients with UC amounting to around 3 extra cases of cancer per 1000 years. Cancer risks varied more among groups defined by age than by treatment.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":8.7000,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203221/pdf/","citationCount":"0","resultStr":"{\"title\":\"Cancer incidence in patients with ulcerative colitis naïve to or treated with thiopurine and targeted therapies-a cohort study 2007 to 2022 with comparison to the general population.\",\"authors\":\"Åsa H Everhov, Johan Askling, Jonas Söderling, Jonas Halfvarson, Julia Eriksson, Karin E Smedby, Jonas F Ludvigsson, Henrik Toft Sørensen, Ola Olén\",\"doi\":\"10.1093/ecco-jcc/jjaf091\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Cancer incidence data including absolute risk differences are needed for clinical risk communication to patients receiving modern-day treatments for ulcerative colitis (UC).</p><p><strong>Methods: </strong>We linked nationwide Swedish health registers and assessed incident cancers in patients with UC in 2007-2022. We computed age-stratified incidence rates (IRs), IR differences, and hazard ratios (HRs) in a naïve cohort with no immunomodulatory treatment, and in cohorts treated with thiopurine or targeted therapies. General population comparator subjects were matched (by age, sex, calendar year, and area of residence) to each treatment cohort. We used a once-exposed-always-exposed design.</p><p><strong>Results: </strong>We identified 63 925 patients with UC in partly overlapping cohorts and 593 072 comparators with a total follow-up time of 5 800 089 years (median 8.1 years). The IRs were elevated compared to the general population in naïve patients: 2.7 extra cancer cases per 1000 person-years (HR: 1.12, 95% CI, 1.09-1.16), in thiopurine-treated patients: 3.4 extra cases (HR: 1.48;1.37-1.61), tumor necrosis factor inhibitor (TNFi)-treated: 2.7 extra cases (HR: 1.41;1.24-1.62), Thiopurine + TNFi-treated: 2.42 extra cases (HR: 1.44;1.19-1.75), vedolizumab-treated: 2.88 extra cases (HR: 1.27;0.90-1.79). The IR differences were not significantly increased in patients treated with ustekinumab 0.57 (HR: 0.87;0,39-1.93) and tofacitinib -0.69 (HR: 0.84;0.25-2.77). Across all treatment groups, the IR differences compared to the general population were highest in patients ≥ 60 years. The differences were driven by colorectal cancer, hepatobiliary cancer, lymphoma, and basal cell skin carcinoma.</p><p><strong>Conclusions: </strong>Elevated cancer incidence was observed in patients with UC amounting to around 3 extra cases of cancer per 1000 years. Cancer risks varied more among groups defined by age than by treatment.</p>\",\"PeriodicalId\":94074,\"journal\":{\"name\":\"Journal of Crohn's & colitis\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":8.7000,\"publicationDate\":\"2025-06-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203221/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Crohn's & colitis\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/ecco-jcc/jjaf091\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Crohn's & colitis","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/ecco-jcc/jjaf091","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Cancer incidence in patients with ulcerative colitis naïve to or treated with thiopurine and targeted therapies-a cohort study 2007 to 2022 with comparison to the general population.
Background: Cancer incidence data including absolute risk differences are needed for clinical risk communication to patients receiving modern-day treatments for ulcerative colitis (UC).
Methods: We linked nationwide Swedish health registers and assessed incident cancers in patients with UC in 2007-2022. We computed age-stratified incidence rates (IRs), IR differences, and hazard ratios (HRs) in a naïve cohort with no immunomodulatory treatment, and in cohorts treated with thiopurine or targeted therapies. General population comparator subjects were matched (by age, sex, calendar year, and area of residence) to each treatment cohort. We used a once-exposed-always-exposed design.
Results: We identified 63 925 patients with UC in partly overlapping cohorts and 593 072 comparators with a total follow-up time of 5 800 089 years (median 8.1 years). The IRs were elevated compared to the general population in naïve patients: 2.7 extra cancer cases per 1000 person-years (HR: 1.12, 95% CI, 1.09-1.16), in thiopurine-treated patients: 3.4 extra cases (HR: 1.48;1.37-1.61), tumor necrosis factor inhibitor (TNFi)-treated: 2.7 extra cases (HR: 1.41;1.24-1.62), Thiopurine + TNFi-treated: 2.42 extra cases (HR: 1.44;1.19-1.75), vedolizumab-treated: 2.88 extra cases (HR: 1.27;0.90-1.79). The IR differences were not significantly increased in patients treated with ustekinumab 0.57 (HR: 0.87;0,39-1.93) and tofacitinib -0.69 (HR: 0.84;0.25-2.77). Across all treatment groups, the IR differences compared to the general population were highest in patients ≥ 60 years. The differences were driven by colorectal cancer, hepatobiliary cancer, lymphoma, and basal cell skin carcinoma.
Conclusions: Elevated cancer incidence was observed in patients with UC amounting to around 3 extra cases of cancer per 1000 years. Cancer risks varied more among groups defined by age than by treatment.
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