TNFα antagonists, non-TNF biologics both safe for treating IBD in cancer patients

Tumour necrosis factor (TNF)-α antagonists show comparable safety as non-TNF biologics in the treatment of inflammatory bowel disease (IBD) in patients with active or recent cancer, as shown in a study.

The study included 125 patients with active cancer (mean age 54 years, 75 percent solid organ malignancy) and 170 patients with recent prior cancer (≤5 years, mean age 53 years, 84 percent solid organ malignancy, mean duration of remission 19 months). Both cohorts were treated with TNFα antagonists or non-TNF biologics for IBD after cancer diagnosis.

Researchers examined the use of either TNFα antagonists or non-TNF biologics for IBD in relation to the primary outcomes of progression-free survival (PFS) in the active cancer cohort or recurrence-free survival in the recent cancer cohort. They compared safety using inverse probability of treatment weighting (IPTW) with propensity scores.

In the active cancer cohort with 483.8 person-years of follow-up, 10 of 55 patients treated with TNFα antagonists and nine of 40 patients treated with non-TNF biologics had cancer progression (incidence rates [IRs], 4.4 and 10.4 per 100 person-years, respectively). PFS did not significantly differ between TNFα antagonists and non-TNF biologics (hazard ratio [HR], 0.76, 95 percent confidence interval [CI], 0.25–2.30).

In the recent cancer cohort with 513 person-years of follow-up, eight of 78 patients treated with TNFα antagonists and five of 66 patients treated with non-TNF biologics had cancer recurrence (IRs, 3.4 and 3.7 per 100 person-years, respectively). Similar to the results in the active cancer cohort, the risk of recurrence-free survival in the recent cancer cohort was similar in the two treatment groups (HR, 0.94, 95 percent CI, 0.24–3.77).

The findings indicate that the choice of therapy for IBD in patients with active or recent cancer should be dictated by disease severity in collaboration with an oncologist.