No Support for Lymphoma Risk With Anti-TNF Therapy for Pediatric IBD

By Megan Brooks

January 26, 2020

NEW YORK (Reuters Health) - A new study finds no support for an increased risk of lymphoma in children with inflammatory bowel disease (IBD) treated with anti-tumor necrosis factor (TNF) agents.

Anti-TNF drugs are very effective for IBD, but alarm bells rang several years ago regarding a possible association with lymphoma. The new data are "reassuring," lead researcher Dr. Matthew D. Egberg, of the University of North Carolina, Chapel Hill, told Reuters Health by phone.

He reported his research this week in Austin, Texas, at the Crohn's and Colitis Congress, sponsored by the Crohn's and Colitis Foundation and the American Gastroenterological Association (AGA).

The research team analyzed data on more than 9,200 children with IBD (mean age, 13.7 years; 47% female). Roughly two-thirds had Crohn's disease.

During an average follow-up of 24 months, 21% of the children were treated with an anti-TNF agent and 38% with an immune modulator (thiopurine or methotrexate). Nearly 8.5% initiated an anti-TNF agent while treated with an immune modulator, of which 90% were thiopurines.

Only three cases of lymphoma were identified over 25,413 person-years of follow-up (incidence rate, 11.8 cases/100,000 person-years). None were hepatosplenic T cell lymphoma, "a very aggressive type that does not respond well to chemotherapy," Dr. Egberg noted.

In none of the cases of lymphoma was the child exposed to either an anti-TNF and/or an immune modulator. "It doesn't prove a lack of risk, but it does further support that, if there is a risk, it's very low," Dr. Egberg told Reuters Health.

"These results support prioritization of the clinical benefits of anti-TNF agents over the low risk for malignancy," he and his colleagues conclude in their meeting abstract.

Dr. David Rubin, chair of the organizing committee for the Crohn's and Colitis Congress, agreed that the data are "overall reassuring."

"One criticism of the study would be that they didn't have enough outcomes of interest to show anything. Of course, if there was anything significant going on, it would have popped up here somewhere," Dr. Rubin, a of medicine at the University of Chicago, told Reuters Health by phone.

The study had no commercial funding and the authors have no relevant conflicts of interest.

SOURCE: Crohn's and Colitis Congress, presented January 23, 2020.