Researchers from the University of Pennsylvania, Perelman School of Medicine, and the Corporal Michael J. Crescenz Veterans Affairs (VA) Medical Center and colleagues conducted a retrospective cohort study among patients with IBD from a VA data set.
Researchers focused on TP exposure, dividing the more than 56,000 patient records into four groups: 1) never exposed to TP; 2) past TP use discontinued more than 6 months previously; 3) current TP use with a cumulative exposure of less than 2 years; and 4) current TP use with a cumulative exposure of 2 or more years.
Thiopurines, including azathioprine, mercaptopurine, and thioguanine, are immunomodulating agents often used to maintain corticosteroid-free remission in patients with Crohn’s disease or ulcerative colitis.
Among 56,314 study patients, 107 developed AML/MDS. The overall incidence of AML/MDS in the IBD population was 18.7 per 100,000 patient-years, the authors noted in a report published the American Journal of Gastroenterology.
Results indicate that incidences among those never exposed to TPs, past users of TPs, current users of TPs with a cumulative exposure of less than 2 years, and current users of TPs with a cumulative exposure of 2 years or more were 17.0, 17.7, 30.4, and 30.3 per 100,000 patient-years, respectively.
Further analysis suggests that, compared with those never exposed to TPs, current use of TPs was associated with increased risk (adjusted hazard ratio [HR] 3.05; 95% CI, 1.54-6.06, P = .0014 for current use of TPs with a cumulative exposure of less than 2 years and adjusted HR 2.32; 95% CI, 1.22-4.41, P = .0101 for current use of TPs with a cumulative exposure of 2 years or more), although past TP exposure was not.
“Among patients with IBD, current TP use was associated with an increased risk of AML/MDS, which reverts to baseline after discontinuation of TP use,” the authors concluded.
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