TY - JOUR

T1 - Systematic Review with Meta-analysis

T2 - The Impact of Cancer Treatments on the Disease Activity of Inflammatory Bowel Diseases

AU - Grimsdottir, Sigrun

AU - Attauabi, Mohamed

AU - Kristine Dahl, Emilie

AU - Burisch, Johan

AU - Seidelin, Jakob Benedict

N1 - Publisher Copyright: © 2023 The Author(s). Published by Oxford University Press on behalf of European Crohn's and Colitis Organisation. All rights reserved.

PY - 2023

Y1 - 2023

N2 - Background and Aims: The association between cancer treatments and exacerbation of inflammatory bowel diseases [IBD] is unclear. We aimed to evaluate the effects of cancer treatments on the disease activity of IBD. Methods: We performed a systematic review of the literature on cancer therapy in patients with pre-existing IBD. Electronic searches of PubMed, Cochrane Library and Embase were combined with manual searches (September 2021). Meta-analysis was performed using the random-effects model. The primary outcome was flares of IBD following cancer therapy. Secondary outcomes were need for IBD-related hospitalization, surgery, and initiation or intensification of steroid or biological treatments to manage IBD flares. Results: In total, 33 studies were included in the systematic review, comprising 1298 patients with IBD who received cancer treatment. The overall occurrence of IBD flares following cancer treatment was 30% (95% confidence interval [CI] 23-37%). IBD flares resulted in utilization of systemic steroids and biologic therapies among 25% and 10% of patients, respectively, and in discontinuation of cancer treatment among 14% of patients. Finally, the risk of gastrointestinal toxicity following immune check point inhibitor treatment [ICI] was increased in patients with IBD compared to patients without IBD (RR = 3.62 [95% CI 2.57-5.09]). Despite this, the studies generally reported that flares were manageable. Conclusions: Current data indicate a high proportion of patients with IBD experiencing a flare following the start of cancer treatment. Patients with IBD were at an increased risk of gastrointestinal toxicity following ICI treatment compared to those without IBD. However, cancer therapy-induced IBD flares were manageable and should not preclude appropriate cancer treatments.

AB - Background and Aims: The association between cancer treatments and exacerbation of inflammatory bowel diseases [IBD] is unclear. We aimed to evaluate the effects of cancer treatments on the disease activity of IBD. Methods: We performed a systematic review of the literature on cancer therapy in patients with pre-existing IBD. Electronic searches of PubMed, Cochrane Library and Embase were combined with manual searches (September 2021). Meta-analysis was performed using the random-effects model. The primary outcome was flares of IBD following cancer therapy. Secondary outcomes were need for IBD-related hospitalization, surgery, and initiation or intensification of steroid or biological treatments to manage IBD flares. Results: In total, 33 studies were included in the systematic review, comprising 1298 patients with IBD who received cancer treatment. The overall occurrence of IBD flares following cancer treatment was 30% (95% confidence interval [CI] 23-37%). IBD flares resulted in utilization of systemic steroids and biologic therapies among 25% and 10% of patients, respectively, and in discontinuation of cancer treatment among 14% of patients. Finally, the risk of gastrointestinal toxicity following immune check point inhibitor treatment [ICI] was increased in patients with IBD compared to patients without IBD (RR = 3.62 [95% CI 2.57-5.09]). Despite this, the studies generally reported that flares were manageable. Conclusions: Current data indicate a high proportion of patients with IBD experiencing a flare following the start of cancer treatment. Patients with IBD were at an increased risk of gastrointestinal toxicity following ICI treatment compared to those without IBD. However, cancer therapy-induced IBD flares were manageable and should not preclude appropriate cancer treatments.

KW - Chemotherapy

KW - gastrointestinal toxicity

KW - IBD flare

U2 - 10.1093/ecco-jcc/jjad010

DO - 10.1093/ecco-jcc/jjad010

M3 - Review

C2 - 36682029

AN - SCOPUS:85151368118

VL - 17

SP - 1139

EP - 1153

JO - Journal of Crohn's & colitis

JF - Journal of Crohn's & colitis

SN - 1873-9946

IS - 7

ER -