| Title: |
Reduced risk of colorectal cancer with non-sulfasalazine 5-ASAs in ulcerative colitis and Crohn’s disease and anti-TNF therapy in ulcerative colitis: a systematic review and meta-analysis |
| Authors: |
Kefayat, A; Porter, RJ; Churchhouse, AM; Blackwell, J; Watson, EF; Morris, AJ; Gordon, M; Nigam, GB; East, JE; Rutter, MD; Lamb, CA; Raine, T; Ford, AC; Din, S |
| Publisher Information: |
BMJ Publishing Group |
| Publication Year: |
2025 |
| Collection: |
Oxford University Research Archive (ORA) |
| Description: |
Objective: The incidence of colorectal cancer (CRC) remains elevated in the inflammatory bowel disease (IBD) population. We aimed to examine the association of biologics, 5-aminosalicylates (5-ASAs) and immunomodulators with the risk of CRC and/or dysplasia (CRC/Dys) in different IBD phenotypes. Methods: We searched Web of Science, PubMed, MEDLINE and EMBASE from inception to 15 March 2025 for all studies assessing the association of biologics, 5-ASAs and immunomodulators on the occurrence of CRC/Dys in adults (≥16 years) with IBD. No randomised controlled trials were identified. Data were pooled using a random effects model generating relative risk (RR) estimates. Results: Fifty observational studies containing 29 325 cases of CRC/Dys in 1 434 939 patients with IBD were included. Biologic therapies (RR 0.74; 95% CI 0.64 to 0.85, I2=56.8%) and 5-ASAs (RR 0.78; 95% CI 0.70 to 0.86, I2=52.1%) were associated with a reduced risk of CRC/Dys in patients with IBD. Immunomodulators were not associated with a reduced risk (RR 0.92; 95% CI 0.82 to 1.02, I2=82.7%). After stratification for IBD phenotypes, medication subgroups and CRC outcome, anti-tumour necrosis factor (anti-TNF) therapies were associated with a reduced risk of CRC in patients with ulcerative colitis (RR 0.78; 95% CI 0.73 to 0.83, I2=0%) but not in Crohn’s disease. Non-sulfasalazine 5-ASAs were associated with a reduced risk of CRC in ulcerative colitis (RR 0.66; 95% CI 0.45 to 0.96, I2=75.4%) and Crohn’s disease (RR 0.84; 95% CI 0.81 to 0.87, I2=41.9%). Conclusion: Use of anti-TNF biologics or non-sulfasalazine 5-ASAs is associated with a reduction in CRC risk in IBD, with differential effects by IBD phenotype. PROSPERO registration number: CRD42024559501. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1136/flgastro-2025-103409 |
| Availability: |
https://doi.org/10.1136/flgastro-2025-103409; https://ora.ox.ac.uk/objects/uuid:676873a8-1ee3-4630-b894-b45c8f5ff2d0 |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.92DD510 |
| Database: |
BASE |