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Crohn's Disease Forum » Treatment » Remicade/Infliximab » Thoughts on remicade and lymphoma?


02-02-2016, 03:20 PM   #1
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Thoughts on remicade and lymphoma?

I'm currently on 40mg prednisone and 250mg azathiapurine. My Dr wants me to go on remicade but I was reading about lymphoma as a side effect esp in patients on our previously taken azathipurine. This kinda shit really scares me. Anyone know more about this or looked into it deeply themselves. God forbid, but has anyone on here been affected this way?

Thanks

Chris
02-02-2016, 04:58 PM   #2
Clash
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I'm going to tag my little penguin because she may have the link to the newer studies but they have shown the risk is higher with the thioprines, Aza and 6mp than that of the risk with biologics like remicade.

Initially, they correlated the risk with biologics then further studies show that those on combo therapy or that had been on thiopurines at any point and then put on biologics.

Hopefully, my little penguin can give a better explanation. But when you look at risk, the risk for HSTCL (the type of Lymphoma the studies are discussing) for the average person on the street is 2 out of 10,000 for those on combo therapy it increases to 6 out of 10,000 I believe. Of course this was from the original studies before data shifted to the higher risk being the thiopurines.

My son has never been on thiopurines but he has been on both remicade plus methotrexate injections and now humira plus methotrexate injections. So I do understand your concern. There's really no choice for my son as none of the meds so far have halted the progression of his CD and he also has JSpA a joint condition that is an EIM of IBD.
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02-02-2016, 05:08 PM   #3
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Sorry I just reread your post and saw that you had already read of the risk of AZA at some point then remicade. That's still one of the older ones I believe but my little penguin will hopefully be by to correct me if I'm wrong.
02-02-2016, 07:25 PM   #4
my little penguin
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Abstract
BACKGROUND & AIMS: Thiopurine therapy for inflammatory bowel disease (IBD) has been associated with increased risk for lymphoma. We estimated the relative risk of lymphoma in patients with IBD exposed to thiopurines and compared relative risk values derived from population-based studies with those from referral center-based studies. We investigated whether active use increased risk compared with past use, and whether sex, age, or duration of use affects risk of lymphoma.

METHODS: We searched MEDLINE, EMBASE, and Cochrane databases, as well as conference abstracts and international publications, for the terms "6-MP and lymphoma," "6-mercaptopurine and lymphoma," "thiopurines and lymphoma," "azathioprine and cancer and IBD," "azathioprine and malignancy and IBD," "azathioprine and lymphoma," and "lymphoproliferative and thiopurines." Pooled standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were estimated. The deviance statistic from Poisson models was used to calculate heterogeneity.

RESULTS: Eighteen studies (among 4383 citations) met our inclusion criteria. Overall, the SIR for lymphoma was 4.92 (95% CI, 3.10-7.78), ranging from 2.80 (95% CI, 1.82-4.32) in 8 population studies to 9.24 (95% CI, 4.69-18.2) in 10 referral studies. Population studies demonstrated an increased risk among current users (SIR = 5.71; 95% CI, 3.72-10.1) but not former users (SIR = 1.42; 95% CI, 0.86-2.34). Level of risk became significant after 1 year of exposure. Men have a greater risk than women (relative risk = 1.98; P < .05); both sexes were at increased risk for lymphoma (SIR for men = 4.50; 95% CI = 3.71-5.40 and SIR for women = 2.29; 95% CI = 1.69-3.05). Patients younger than 30 years had the highest relative risk (SIR = 6.99; 95% CI, 2.99-16.4); younger men had the highest risk. The absolute risk was highest in patients older than 50 years (1:354 cases per patient-year, with a relative risk of 4.78).

CONCLUSIONS: Compared with studies from referral centers, population-based studies of IBD patients show a lower but significantly increased risk of lymphoma among patients taking thiopurines. The increased risk does not appear to persist after discontinuation of therapy. Patients over 50 have the highest absolute risk of lymphoma per year on thiopurines, while men under 35 may also be a high risk group. More study is needed to precisely understand groups highest at risk. The risks of lymphoma and potential benefits of therapy should be considered for all patients with IBD.


Risk of lymphoma in patients with inflammatory bowel disease treated with azathioprine and 6-mercaptopurine: a meta-analysis.


From
http://www.ncbi.nlm.nih.gov/m/pubmed/24879926/
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02-02-2016, 08:16 PM   #5
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I think it's also important to consider the risks of not properly treating the disease.
When I was first diagnosed treatment options were very limited. As a result I've had some very serious complications (countless bowel obstructions, 2 perforations; 1 near fatal, toxic mega colon, multiple surgeries, fistulas and abscesses, and I had a major bleed one night in hospital that left the doctorssurprised I made it through the night). This made Remicade a no brainer for me.

Sending you my support.
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02-02-2016, 09:52 PM   #6
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Thanks.. That puts thing in perspective.
02-03-2016, 01:10 AM   #7
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I was untreated for 7 years and it spread, so I am a fan of taking care of it!!
I think my Dr is to conservative- I think 6 years out of remission is unreasonable!

Lauren
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Waiting for the ok from my Ins company to restart Remicade. Will also start Imuron to get into remission!
I know it's out there somewhere and I WILL find it!


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Ok, my family Dr told me to cut down on the stress- a husband, 3 kids, and 3 dogs!
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