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The risk of cancer in pediatric-onset immune-mediated inflammatory diseases - A nationwide study

Andrea Ehrström1, Sabine Jansson1, Marianne Hørby Jørgensen2

  • 1Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents, and Adults, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.

Journal of Autoimmunity
|September 27, 2024
PubMed

Insights

Pediatric-onset immune-mediated inflammatory diseases (pIMID) significantly increase long-term cancer risk. Certain treatments like thiopurines and anti-TNFα are linked to higher risks of lymphoma and skin cancer.

Area of Science:

  • Pediatric Rheumatology
  • Oncology
  • Immunology

Background:

  • Adult-onset immune-mediated inflammatory diseases (IMID) are known cancer risk factors.
  • Data on cancer risk in pediatric-onset IMID (pIMID) is limited.
  • Understanding pIMID's long-term cancer implications is crucial for early intervention.

Purpose of the Study:

  • To estimate the long-term cancer risk in patients with pIMID.
  • To investigate the association between specific medical treatments and cancer development in pIMID patients.
  • To inform clinical management and surveillance strategies for pIMID.

Main Methods:

  • Nationwide Danish health registers used to identify 12,664 pIMID patients (diagnosed 1980-2018).
  • pIMID patients were matched with 109,274 reference individuals.
  • Cancer risk assessed, with specific focus on immunomodulators and anti-TNFα therapies.

Main Results:

  • pIMID patients exhibited a twofold higher cancer risk (AHR 2.2) compared to controls.
  • Thiopurine treatment correlated with increased lymphoma and skin cancer risks (AHR 6.1 for both).
  • Anti-TNFα treatment was associated with a higher risk of lymphoma (AHR 4.9).

Conclusions:

  • pIMID is associated with elevated cancer risk extending into adulthood.
  • Thiopurine and anti-TNFα therapies require careful consideration due to potential links with specific cancers.
  • Individualized immunotherapy and vigilant cancer surveillance are essential for pIMID management.
Abstract

Keywords:
Autoimmune hepatitisCrohn's diseaseJuvenile idiopathic arthritisPrimary sclerosing cholangitisSystemic lupus erythematosusUlcerative colitis

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