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Risk of Myeloproliferative Neoplasms in Patients With Inflammatory Bowel Disease and Impact on Outcomes: A
Mohamed H Eldesouki1, Ahmed Ibrahim2, Muhammed M Marey3
1Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, New Jersey, USA.
Background:
Inflammatory bowel disease (IBD) and myeloproliferative neoplasms (MPNs) share chronic inflammation and immune dysregulation.
Aim:
We evaluated the incidence of MPNs among patients with IBD and clinical outcomes of IBD-MPN coexistence.
Methods:
Two retrospective cohort analyses were conducted using the TriNetX database. First, adults with ulcerative colitis (UC) or Crohn's disease (CD) were compared with matched non-IBD controls to estimate incident MPN risk. A coexistence second analysis included patients with UC or CD who developed MPNs and then were matched to IBD without MPN controls to assess 5-year outcomes, including IBD-related complications, surgical interventions, colorectal cancer (CRC) and primary sclerosing cholangitis (PSC). Medication subgroup analyses were performed to evaluate associations with MPN risk.
Results:
After matching, 3873 patients with UC-MPN and 3474 patients with CD-MPN were included. Compared with matched non-IBD controls, incident MPN risk was higher in UC (HR 1.60, p = 0.01) and CD (HR 1.56, p < 0.001). In CD, MPN coexistence was associated with higher risks of CRC (HR 1.52, p = 0.012), intestinal fistula (HR 2.84, p < 0.001), obstruction (HR 2.05, p < 0.001), perforation (HR 2.37, p < 0.001), small bowel resection (HR 3.69, p < 0.001) and colectomy (HR 2.10, p < 0.001). In UC, MPN coexistence was associated with higher risks of CRC (HR 1.50, p = 0.001), PSC (HR 1.75, p = 0.03) and pouchitis (HR 1.68, p = 0.003). Exposure to thiopurines (HR 1.28, p < 0.001) was associated with increased MPN risk, whereas TNF, IL-23 and JAK inhibitors were not.
Conclusions:
IBD is associated with increased MPN risk, and IBD-MPNs coexistence is associated with worse IBD-related complications and malignancy risk.
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