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Inflammatory Bowel Disease Drugs Could Increase Leukemia Risk

Thiopurines linked to myeloid disorders

Immunosuppressive drugs called thiopurines have been found to increase the risk of myeloid disorders, such as acute myeloid leukemia and myelodysplastic syndrome (a rare bone-marrow disorder), seven-fold in patients with inflammatory bowel disease (IBD), according to a new report in Clinical Gastroenterology and Hepatology.

Thiopurines are used to reduce inflammation and to provide symptom relief in patients with IBD.

“In order to make appropriate, informed decisions about thiopurines, patients and providers need to be well-educated about the risks and benefits of this treatment,” said lead author Laurent Peyrin-Biroulet, MD, PhD. “According to our research, the risk of myeloid disorders was not increased among the overall IBD population, compared with the general population; however, it was increased among those taking thiopurines. We hope these findings encourage other researchers to investigate more about the drug and its potentially harmful effects.”

Researchers in France conducted a prospective observational study of 19,486 patients with IBD exposed to thiopurines between May 2004 and June 2005. After 3 years of follow-up, five patients were diagnosed with incident myeloid disorders. Four of these patients had been previously exposed to thiopurines. Patients who did not receive thiopurines during the study period and those who never received the drugs did not have an increased risk of myeloid disorders.

While these findings provide evidence of a connection between thiopurines and myeloid disorders in IBD patients, the absolute risk to an individual patient is only 1 in 10,000, the authors noted. The link between IBD patients treated with thiopurines and myeloid disorders remains complex. Physicians need to balance this risk against the known benefits of thiopurines in the management of IBD, the authors remarked.

The American Gastroenterological Association has developed a guideline-based clinical decision support tool to help providers determine when to use thiopurines in the management of patients with IBD.

Sources: AGA; August 6, 2014; and Clinical Decision Support Tool; 2013.

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