BACKGROUND - The risk of urinary tract cancers, including kidney and bladder cancers, was increased in transplant recipients receiving thiopurines.
AIM - To assess the risk of urinary tract cancers in patients with inflammatory bowel disease (IBD) receiving thiopurines in the CESAME observational cohort.
METHODS - Between May 2004 and June 2005, 19 486 patients with IBD, 30. 1% of whom were receiving thiopurines, were enrolled. Median follow-up was 35 months (IQR: 29-40).
RESULTS - Ten and six patients developed respectively kidney and bladder cancer. The incidence rates of urinary tract cancer were 0. 48/1000 patient-years in patients receiving thiopurines (95% CI: 0. 21-0. 95), 0. 10/1000 patient-years in patients who discontinued thiopurines (95% CI: 0. 00-0. 56) and 0. 30/1000 patient-years in patients never treated with thiopurines (95% CI: 0. 12-0. 62) at entry. The standardised incidence ratio of urinary tract cancer was 3. 40 (95% CI: 1. 47-6. 71, P = 0. 006) in patients receiving thiopurines, 0. 64 (95% CI: 0. 01-3. 56, P = 0. 92) in patients previously exposed to thiopurines and 1. 17 (95% CI: 0. 47-12. 42, P = 0. 78) in patients never treated with thiopurines. The multivariate-adjusted hazard ratio (HR) of urinary tract cancer between patients receiving thiopurines and those not receiving thiopurines was 2. 82 (95% CI: 1. 04-7. 68, P = 0. 04). Other significant risk factors were male gender (HR: 3. 98, 95% CI: 1. 12-14. 10, P = 0. 03) and increasing age (HR after 65 years (ref <50): 13. 26, 95% CI: 3. 52-50. 03, P = 0. 0001).
CONCLUSIONS - Patients with IBD receiving thiopurines have an increased risk of urinary tract cancers. Clinically relevant excess risk is observed in older men.
Alimentary pharmacology & therapeutics. 2015 Nov 09 [Epub ahead of print]
A Bourrier, F Carrat, J-F Colombel, A-M Bouvier, V Abitbol, P Marteau, J Cosnes, T Simon, L Peyrin-Biroulet, L Beaugerie
Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, Paris, France. , Department of Public Health, AP-HP, Hôpital Saint-Antoine, Paris, France. , The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. , Registre Bourguignon des Cancers Digestifs, Inserm U866, CHRU Dijon, FRANCIM, Dijon, France. , Department of Gastroenterology, AP-HP, Hôpital Cochin-Port Royal, Paris, France. , Department of gastroenterology, AP-HP, Hôpital Lariboisière, Paris, France. , Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, Paris, France. , Clinical Pharmacology Unit, Unité de Recherche clinique de l'Est Parisien, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France. , Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France. , Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, Paris, France.