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Trastornos linfoproliferativos en pacientes que reciben tiopurinas para la enfermedad inflamatoria intestinal: un
Laurent Beaugerie1, Nicole Brousse, Anne Marie Bouvier
1Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Université Pierre et Marie Curie Paris-VI, Paris, France. laurent.beaugerie@sat.aphp.fr
Lancet (London, England)
|October 20, 2009
Resumen
Los pacientes con enfermedad inflamatoria intestinal en terapia con tiopurina se enfrentan a un riesgo significativamente mayor de desarrollar trastornos linfoproliferativos. Este riesgo es notablemente elevado en comparación con aquellos que nunca han usado estos fármacos inmunosupresores.
Área de la Ciencia:
- Inmunología Inmunología.
- Gastroenterología y Gastroenterología.
- Oncología Oncología.
Sus antecedentes:
- Existe controversia con respecto al aumento del riesgo de trastornos linfoproliferativos en pacientes con enfermedad inflamatoria intestinal (EII) que usan tiopurinas.
- Se realizó un estudio prospectivo de cohorte observacional para evaluar este riesgo.
Objetivo del estudio:
- Para evaluar el riesgo de trastornos linfoproliferativos en pacientes con enfermedad inflamatoria intestinal (EII) expuestos a terapia con tiopurina.
- Para comparar la incidencia de estos trastornos entre pacientes que reciben, interrumpen o nunca usan tiopurinas.
Principales métodos:
- Una cohorte nacional francesa incluyó a 19.486 pacientes con EII, con datos recopilados por 680 gastroenterólogos.
- El seguimiento fue de un promedio de 35 meses, documentando terapia inmunosupresora, cánceres y muertes.
- El riesgo de trastorno linfoproliferativo se analizó en función del estado de exposición a la tiopurina.
Principales resultados:
- Se diagnosticaron 23 nuevos casos de trastorno linfoproliferativo (1 de Hodgkin, 22 no Hodgkin).
- Las tasas de incidencia por cada 1000 pacientes-años fueron de 0,90 (recibiendo tiopurinas), 0,20 (interrumpido) y 0,26 (nunca recibido).
- El análisis multivariado mostró una relación de riesgo de 5,28 para el trastorno linfoproliferativo en los receptores de tiopurina frente a los no receptores (p = 0,0007).
Conclusiones:
- Los pacientes que reciben tiopurinas para la enfermedad inflamatoria intestinal presentan un mayor riesgo de desarrollar trastornos linfoproliferativos.
- El perfil patológico de muchos casos asociados a la tiopurina se parecía a la enfermedad linfoproliferativa post-transplante.
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