Cumulative immunomodulator exposure may heighten risk of CIN2+ in IBD

Among women with inflammatory bowel disease (IBD), those who have long-term immunomodulator exposure are at increased risk of high-grade cervical intraepithelial neoplasia and cervical cancer (CIN2+), according to a study.

For the study, researchers used data from the Dutch IBD biobank and identified adult women diagnosed with IBD who had available cervical records on the nationwide cytopathology database.

Analyses were performed to estimate the CIN2+ incidence rates among participants exposed to immunomodulators (thiopurines, methotrexate, tacrolimus, and cyclosporine) and biologics (anti-tumour necrosis factor, vedolizumab, and ustekinumab), as well as to compare the incidence rates between exposed patients and unexposed patients. Risk factors were also assessed. Cumulative exposure to immunosuppressive drugs was evaluated in extended time-dependent Cox-regression models.

A total of 1,981 female participants with IBD were included in the analysis. Of these participants, 99 (5 percent) were diagnosed with CIN2+ over median follow-up of 17.2 years.

Overall, 1,305 (66 percent) participants were exposed to immunosuppressive drugs, including immunomodulators (58 percent), biologics (40 percent), or both immunomodulators and biologics (33 percent).

Each year of exposure to immunomodulators was associated with a 16-percent increase in the risk of CIN2+ risk increased by (hazard ratio [HR], 1.16, 95 percent confidence interval [CI], 1.08–1.25). This association was not observed for biologics and both biologics and immunomodulators.

In multivariate analysis, other factors independently associated with CIN2+ detection included smoking (HR, 2.73, 95 percent CI, 1.77–4.37) and 5-yearly screening frequency (HR, 1.74, 95 percent CI, 1.33–2.27).

The findings highlight the potential of active counselling of IBD women to participate in cervical screening programs. Nevertheless, further studies are needed to establish the benefit of intensified screening of women with IBD on long-term immunomodulator exposure.