Primary sclerosing cholangitis cuts survival in IBD patients

Patients with inflammatory bowel diseases (IBDs) suffer from higher mortality rates and are at an increased risk of cancer when they develop new-onset primary sclerosing cholangitis (PSC), a recent study has found.

Linking national medical and census databases in England, researchers identified 284,560 patients with incident IBD between April 2006 and 2016. Of these, 2,588 developed PSC. The primary goal of the study was to quantify the impact of new-onset PSC in IBD patients, across all subtypes, assessing its effect on disease outcomes and mortality.

The cumulative follow-up, until death or censor, was 1,994,441 person-years for those with IBD alone, and 18,823-person-years for IBD patients who developed PSC.

The onset of PSC worsened survival independently of sex, race, comorbidities, and ageing (time-dependent hazard ratio [HR], 3.20, 95 percent confidence interval [CI], 3.01–3.40; p<0.001).

Moreover, relative to the background population, the years of life lost following IBD diagnosis were 12.7 and 12.6 years in men and women with IBD alone. In comparators who developed PSC, the respective values were 17.1 and 16.4 years.

PSC onset also seemed to correlate with malignancies, with significantly elevated risk estimates for pancreatic cancer (time-dependent adjusted HR, 5.26, 95 percent CI, 2.81–9.84; p<0.001) and gallbladder cancer (adjusted HR, 9.19, 95 percent CI, 2.91–29.05). Another 164 PSC-IBD patients developed cholangiocarcinoma, while 47 had hepatocellular carcinoma. For all malignancies, advancing age at PSC diagnosis emerged as a significant risk factor.