Philadelphia—Pharmacists might caution inflammatory bowel disease (IBD) patients to have regular dermatologist visits if they are on a common therapy.

A new study suggests that treatment with thiopurines is associated with an increased risk of fatal squamous cell carcinoma of the skin (SCC) in IBD patients. Azathioprine and 6-mercaptopurine often are used to treat Crohn’s disease or ulcerative colitis.

Researchers from the Corporal Michel J. Crescenz VAMC and the University of Pennsylvania Perelman School of Medicine, both in Philadelphia, focused on outcomes of patients with IBD who developed SCC while receiving thiopurine therapy.

Results of the retrospective cohort study of 54,919 patients with IBD followed in the nationwide Veterans Administration Healthcare System from January 1, 2000, through May 23, 2018, were reported in Clinical Gastroenterology and Hepatology.

From the larger cohort, the study team created a subcohort of patients with an incident diagnosis of SCC, confirmed by review of patients’ medical records.

Those who had received treatment with thiopurines (exposed group) versus those treated with 5-ASA and no prior exposure to thiopurines or tumor necrosis factor antagonists (unexposed group) were identified.

Defined as the primary outcome was death associated with SCC (SCC mortality). Data was also collected on baseline demographic features, exposure to ultraviolet light, Charlson comorbidity index, smoking status, and environmental exposures.

For the study, follow-up began at the time of incident SCC diagnosis and ended at death or last recorded date in the health system. Cause-specific hazard models were used to estimate the adjusted and unadjusted hazard ratio (HRs), with 95% CIs, for SCC mortality.

Overall, 467 patients with incident SCC and included 449 patients—161 exposed and 288 unexposed—were used in the final analysis. Of those, 11 patients died from complications of SCC, eight in the exposed group and three in the unexposed group. The estimated 5- and 10-year cumulative mortality values were 2.9% and 2.9% in the exposed group and 0.4% and 0.9% in the unexposed group, respectively, according to the researchers.

The unadjusted and adjusted cause-specific HRs for SCC mortality associated with exposure were 7.0 (95% CI, 1.8-28.0; P =.006) and 8.0 (95% CI, 2.0-32.8; P =.004), respectively, the study calculated.

“Although the cause-specific mortality is relatively low, patients with IBD exposed to thiopurines who develop SCC have an increased risk of SCC-associated death compared to patients exposed to only 5-ASA,” study authors concluded.

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