Comparative Safety of Biologic Agents in Patients With Inflammatory Bowel Disease With Active or Recent Malignancy: A Multi-Center Cohort Study

• DOI: 10.1016/j.cgh.2023.01.002
• Publication Date: 2023-01-13T08:40:46Z
• Authors: Ariela K. Holmer; Jiyu Luo; Kirk B. Russ; Sarah Park; Jeong Yun Yang; Furkan Ertem; Jeffrey Dueker; Vu Nguyen; Simon Hong; Cameron Zenger; Jordan E. Axelrad; Anthony Sofia; Jessica C. Petrov; Badr Al-Bawardy; David I. Fudman; Ernesto Llano; Joseph Dailey; Sushrut Jangi; Nidah Khakoo; Oriana M. Damas; Edward L. Barnes; Frank I. Scott; Ryan C. Ungaro; Siddharth Singh
• Keywords: Adult; Biological Factors; Biological Products; Tumor Necrosis Factor-alpha; Neoplasms; Humans; Tumor Necrosis Factor Inhibitors; Middle Aged; Inflammatory Bowel Diseases; 3. Good health; Aged; Retrospective Studies

Safety of biologic agents is a key consideration in patients with inflammatory bowel disease (IBD) and active or recent cancer. We compared the safety of tumor necrosis factor (TNF)-α antagonists vs non-TNF biologics in patients with IBD with active or recent cancer.We conducted a multicenter retrospective cohort study of patients with IBD and either active cancer (cohort A) or recent prior cancer (within ≤5 years; cohort B) who were treated with TNFα antagonists or non-TNF biologics after their cancer diagnosis. Primary outcomes were progression-free survival (cohort A) or recurrence-free survival (cohort B). Safety was compared using inverse probability of treatment weighting with propensity scores.In cohort A, of 125 patients (483.8 person-years of follow-up evaluation) with active cancer (age, 54 ± 15 y, 75% solid-organ malignancy), 10 of 55 (incidence rate [IR] per 100 py, 4.4) and 9 of 40 (IR, 10.4) patients treated with TNFα antagonists and non-TNF biologics had cancer progression, respectively. There was no difference in the risk of progression-free survival between TNFα antagonists vs non-TNF biologics (hazard ratio, 0.76; 95% CI, 0.25-2.30). In cohort B, of 170 patients (513 person-years of follow-up evaluation) with recent prior cancer (age, 53 ± 15 y, 84% solid-organ malignancy; duration of remission, 19 ± 19 mo), 8 of 78 (IR, 3.4) and 5 of 66 (IR 3.7) patients treated with TNFα antagonists and non-TNF biologics had cancer recurrence, respectively. The risk of recurrence-free survival was similar between both groups (hazard ratio, 0.94; 95% CI, 0.24-3.77).In patients with IBD with active or recent cancer, TNFα antagonists and non-TNF biologics have comparable safety. The choice of biologic should be dictated by IBD disease severity in collaboration with an oncologist.