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      A123 NON-MELANOMA SKIN CANCER IN IBD PATIENTS TAKING 6-TGN ANTIMETABOLITES A POPULATION STUDY

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          Abstract

          Background

          Non-melanoma skin cancer (NMSC) rates have been shown to increase in Inflammatory Bowel Disease (IBD) patients taking 6-thioguanine (6-TGN) antimetabolites (Azathioprine and 6-Mercatopurine). There is limited population-based data assessing the risk of NMSC in IBD patients on 6-TGN and anti-tumor necrosis factor (anti-TNF) therapy.

          Aims

          To determine the risk of NMSC amongst IBD patients on 6-TGN antimetabolites and anti-TNF therapies in a longitudinal, population-based Canadian cohort

          Methods

          This was a retrospective cohort study using population-based administrative data from Saskatchewan (1970 to 2011). IBD and NMSC cases were identified through application of validated administrative definitions to ICD billing codes. Using population-based drug dispensal data IBD cases were classified as “exposed” and “unexposed” to each of 6-TGN antimetabolites and anti-TNF therapies. Univariate and multivariate conditional logistic regression and cox-proportional hazard analyses were performed. Hazard ratios were adjusted for age, sex, location, and medication.

          Results

          A total of 8713 prevalent IBD cases were identified for inclusion, 51.6% CD and 48.4% UC. There were 349 cases of NMSC, 68 patients were exposed to 6-TGN and 281 non-exposed. The unadjusted hazard ratio (HR) was 0.74 in IBD patients exposed to 6-TGN compared to non exposed, p 0.0276 (95% CI 0.57–0.97). Stratified by age (<50 or 50 and older) the adjusted HR was 1.18 in IBD patients <50 years old, p 0.40 (0.8–1.74) and 1.38 ≥50 years old, p 0.1708 (0.87–2.20). The adjusted HR in CD patients < 50 years old was 1.08, p 0.7531 (0.67–1.73) and 1.78 ≥50 years old, p 0.030 (1.06–3.00). The adjusted HR in UC patients < 50 years old was 1.32, p 0.4232 (0.67–2.57) and 0.47 ≥50 years old, p 0.2624 (0.12 – 1.77)

          Conclusions

          Overall, lower rates of NMSC in IBD patients taking 6-TGN compared to those not exposed to 6-TGN were observed. However when stratified for age CD patients greater than age 50 exposed to 6-TGN had statistically higher rates of NMSC compared to those not exposed, suggesting an age-related effect. Analyses to better understand the association between 6-TGN on NMSC risk which explore cumulative exposure to 6-TGN therapy and the impact of anti-TNF on NMSC will be performed. This study contributes additional data that further elucidates the relationship between 6-TGN exposure and development of NMSC

          IBD Type Number of events with exposure Unadjusted Adjusted
          HR 95% CI p-value HR 95% CI p-value
          Age < 50 years only
          IBD (159/6228) 43 0.96 0.67–1.36 0.7989 1.18 0.8–1.74 0.4015
          CD (85/3400) 32 0.91 0.58–1.41 0.6623 1.08 0.67–1.73 0.7531
          UC (74/2828) 11 1.04 0.55–1.97 0.906 1.32 0.67–2.57 0.4232
          Age 50+ years only
          IBD (190/2455) 25 1.32 0.86–2.01 0.203 1.38 0.87–2.20 0.1708
          CD (91/1096) 22 1.52 0.94–2.46 0.0863 1.78 1.06–3.00 0.0300
          UC (99/1389) <6 0.49 0.16–1.56 0.2285 0.47 0.12–1.77 0.2624

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          Author and article information

          Journal
          J Can Assoc Gastroenterol
          J Can Assoc Gastroenterol
          jcag
          Journal of the Canadian Association of Gastroenterology
          Oxford University Press (US )
          2515-2084
          2515-2092
          March 2019
          15 March 2019
          : 2
          : Suppl 2 , Abstracts Accepted to 2019 CDDW™
          : 246-248
          Affiliations
          [1 ]Medicine, Dalhousie University, Halifax, NS, Canada
          [2 ]Gastroenterology, Research Services, QEII Health Sciences Centre, Halifax, NS, Canada
          Article
          PMC6512698 PMC6512698 6512698 gwz006.122
          10.1093/jcag/gwz006.122
          6512698
          44d88c8e-9510-4fcb-9b77-1137c1707a5b
          © The Author(s) 2019. Published by Oxford University Press on behalf of the Canadian Association of Gastroenterology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

          This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

          Page count
          Pages: 3
          Categories
          Posters Of Distinction
          Poster Session 1
          Immunobiology and Inflammatory Bowel Disease

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