Douglas K. Rex, MD reviewing Hyams JS et al. Gastroenterology 2017 Feb 10.

Children treated with infliximab had no excess risk for cancer or hemophagocytic lymphohistiocytosis compared with children not treated with biologic agents.

Recent data in adults suggest that thiopurines are associated with a threefold to fourfold increased risk for lymphoma when used to treat inflammatory bowel disease (IBD) and an increased risk for nonmelanoma skin cancers. Tumor necrosis factor (TNF) blockers without concomitant immunomodulators may not increase the risk for any cancer.

In a manufacturer-sponsored prospective study of long-term outcomes in pediatric patients receiving infliximab and/or other drugs for IBD, 5766 patients (median age, 13 years) were followed for approximately 9 years, yielding 24,543 patient-years of follow-up. Endpoints were cancer and hemophagocytic lymphohistiocytosis (HLH), a disorder associated with immune hyperstimulation and dysregulation that can be fatal.

Of the 5 patients who developed HLH, all had thiopurine exposure, as did 13 of 15 patients who developed cancer. Incidence of HLH or cancer was not increased in patients exposed to infliximab compared with those unexposed to any biologics.

CITATION(S):

Hyams JS et al. Infliximab not associated with increased risk of malignancy or hemophagocytic lymphohistiocytosis in pediatric patients with inflammatory bowel disease. Gastroenterology 2017 Feb 10; [e-pub]. 

JWatch