Related Experiment Video
Updated: Jun 16, 2026
Non-invasive Assessment of the Efficacy of New Therapeutics for Intestinal Pathologies Using Serial Endoscopic Imaging of Live Mice
Published on: March 10, 2015
Risk of cancer in inflammatory bowel disease treated with azathioprine: a UK population-based case-control study
Richard G Armstrong1, Joe West, Timothy R Card
1Department of Gastroenterology, United Lincolnshire Hospitals NHS Trust, Boston, UK.
Objectives:
Azathioprine is an accepted treatment of inflammatory bowel disease (IBD), but concerns exist regarding its carcinogenic potential. Studies in renal transplant and rheumatology patients have reported an increased cancer risk. In IBD, studies suggest a small increased risk of lymphoma and protection against colorectal cancer, but the overall risk of malignancy has not been established.
Methods:
We conducted a nested case-control study using the General Practice Research Database. Records of IBD patients were examined for azathioprine prescriptions and cancers. Prescriptions per year of follow-up were grouped for analysis. Azathioprine use was compared between IBD cases (with a diagnosed cancer) and IBD controls (without).
Results:
Overall, 15,471 patients with IBD and over 1 year of appropriate data were identified. Among these, 392 developed cancer, of whom 10.5% received at least one prescription for azathioprine, compared with 1,914 (12.7%) of the controls. Analyzing the occurrence of any cancer against azathioprine prescription showed a nonsignificant protective effect (odds ratio (OR)=0.92, 95% confidence interval (CI)=0.79-1.06). Correction for the effects of age and smoking removed this effect (OR=1.04, 95% CI=0.89-1.21). Diagnosis of lymphoma was associated with ever use of azathioprine with OR of 3.22, CI=1.01-10.18.
Conclusions:
We found evidence of an increased risk of lymphoma, which is consistent with previous studies. We found no overall increase in risk of cancer in individuals with IBD who had taken azathioprine. Our study does not show a need for azathioprine cessation in the medium term in IBD because of the risk of malignancy.
Related Concept Videos
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
01:25Inflammatory Bowel Disease III: Crohn's Disease
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the colonic...
01:29Drugs for Treatment of Ulcerative Colitis in IBD
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by transmural...
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...