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Increased non-melanoma skin cancer risk in young patients with inflammatory bowel disease on immunomodulatory therapy: a retrospective single-centre cohort study.


Clowry J, Sheridan J, Healy R, Deady S , Keegan D, Byrne K, Cullen G, Mulcahy H, Comber H, Andrew Parnell, Doherty G, Lally

Publication Type: 
Refereed Original Article
Background Recent studies report an increased risk of non-melanoma skin cancer (NMSC) in immunosuppressedpatients with inflammatory bowel disease (IBD). Concurrently, paediatric IBD incidence is rising, with more patients nowexposed to immunomodulators from a younger age.Objectives To investigate NMSC incidence and to examine the risk associated with immunomodulators in the devel-opment of NMSC in patients with IBD.Methods This wa s a retrospective single-centre cohort study. Patien ts with IBD attendin g a tertiary adult hospita l from1994 to 201 3 were included. Skin cancer incidence was compared with population data from the National Cancer Registry ofIreland (NCRI) to calculate standardized incidence ratio (SIR). Logistic regressio n was utilized for risk factor analysis.Results Two thousand and fifty-three patients with IBD were studied. The SIR for NMSC in patients with IBD takingimmunomodulators overall was 1.8 (95% CI: 1.0–2.7) with age-specific rates significantly elevated across certain agecategories. Exposure to thiopurines (OR: 5.26, 95% CI: 2.15–12.93, P < 0.001) and in particular thiopurines and/ortumour necrosis factor alpha (TNF-a) inhibitors (OR: 6.45, 95% CI: 2.69–15.95, P < 0.001) was significantly associatedwith NMSC. The majority (82%) of those exposed to a TNF-a inhibitor also had thiopurine exposure.Conclusions Compliance with skin cancer preventative measures should be highlighted to all patients with IBD. Thereshould be a low threshold for dermatology referral for immunosuppressed patients, particularly those with a history ofexposure to dual immunomodulators from a young age.Received: 18 July 2016; Accepted: 14 December 2016
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Publication Date: 
Journal of the European Academy of Dermatology and Venereology 31(6) · January 2017 
Journal of the European Academy of Dermatology and Venereology,
Research Group: 
National University of Ireland, Dublin (UCD)
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