Introduction: Use of immunosuppressants in inflammatory bowel disease (IBD) patients has been shown to increase the risk of skin cancers. However, there is limited data on risk of skin cancer among IBD patients who are on non-antiTNF advanced therapies. Using a large database, we sought to describe the rates of melanoma and non-melanoma skin cancers among IBD patients based on medications used.
Methods: We queried a multi-institutional database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 US healthcare systems was surveyed. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of inflammatory bowel disease between 2017-2021 was identified. We then identified cohorts of IBD patients based on medications prescribed. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp), multivariate analysis was used to adjust for several factors including prescribed medications. For all analyses, a 2-sided P value of < 0.05 was considered statistically significant.
Results: Of the 34,277,840 individuals in the database, 142,890 (0.42%) and 165,960 (0.48%) had a diagnosis of ulcerative colitis (UC) and Crohn’s disease (CD) respectively. IBD patients were mostly adults (63.8% vs 70.% ) adults, females (60.4% vs 61.1%), and Caucasian (76.2% vs 74.1%) for UC and CD respectively. Among IBD patients who were not previously treated with antiTNFs/immunomodulators, rates of SCC,BCC, and melanoma were 1.3%, 2.6%, and 1.3% for UC treated with ustekinumab, and 1.5%, 2.5%, and 1.5% for UC/vedolizumab and 2.2%, 4.3%, and 1.1% for UC/tofacitinib respectively. In comparison, rates were 1.2%, 2.4%, and 1.0% for CD/ustekinumab and 1.7%, 2.4%, and 1.4% for CD/vedolizumab respectively (Table 1). In the multivariate model, IBD patients were two times higher risk for SCC and melanoma (Table 2).
Discussion: In this large database, we found a higher rates of melanoma and non-melanoma skin cancers among IBD patients treated with Non-AntiTNF Advanced Therapies. Further studies are required to validate these findings and increase attention to adequately screening for skin cancers and make dermatology referral while taking care of IBD patients.
