Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands.
Department of Gastroenterology and Hepatology, Zuyderland Medical Centre, Sittard-Geleen-Heerlen, the Netherlands.
Inflamm Bowel Dis. 2018 Jun 8;24(7):1606-1611. doi: 10.1093/ibd/izy053.
The prevalence of inflammatory bowel disease (IBD) is increasing and, consequently, more IBD patients will develop cancer with need for cancer-associated chemotherapy. Physicians are therefore confronted with whether they should continue, stop, or restart IBD medication in relation with chemotherapy. The current strategy in our hospital is to discontinue immunomodulating IBD medication, comprising corticosteroids, anti-tumour necrosis factor (anti-TNF), and other immunosuppressives, before starting chemotherapy.
Out of 1826 patients with IBD, we analyzed 41 IBD patients who received chemotherapy between January 2006-2017. The primary endpoint was the effect of chemotherapy on IBD course, assessed by number of exacerbations and use of IBD medication. The paired-samples t-test and Wilcoxon Signed-Rank test were performed.
The mean number of IBD exacerbations of 0.3 (0.0-0.6) per 5 years after chemotherapy was lower compared to 1.4 (0.8-1.9) exacerbations per 5 years before chemotherapy exposure (P < 0.01). In terms of IBD medication, there was a decrease in the number of patients using mesalazine (47% vs 71%, P < 0.01) or corticosteroids (9% vs 32%, P = 0.02) in a time span of 5 years after compared to 5 years before chemotherapy. There was also a trend of less use of immunosuppressives (anti-TNF 0% vs 15%, P = 0.25; thiopurines 12% vs 34%, P = 0.13).
Cancer-associated chemotherapy is associated with a more benign course of IBD that may contribute to the decision to discontinue anti-TNF or other immunosuppressives in relation to cancer-associated treatment both before the start of chemotherapy, as well as reinitiating aggressive immunosuppressives for IBD afterwards.
炎症性肠病（IBD）的患病率正在增加，因此，更多的 IBD 患者将需要进行癌症相关的化疗。因此，医生面临的问题是他们应该继续、停止还是重新开始与化疗相关的 IBD 药物治疗。目前，我们医院的策略是在开始化疗前停止免疫调节 IBD 药物治疗，包括皮质类固醇、抗肿瘤坏死因子（anti-TNF）和其他免疫抑制剂。
在 1826 例 IBD 患者中，我们分析了 2006 年至 2017 年期间接受化疗的 41 例 IBD 患者。主要终点是化疗对 IBD 病程的影响，通过 IBD 加重的次数和 IBD 药物的使用来评估。采用配对样本 t 检验和 Wilcoxon 符号秩检验。
化疗后 5 年内 IBD 加重的平均次数为 0.3（0.0-0.6）次/5 年，低于化疗前 5 年内的 1.4（0.8-1.9）次/5 年（P <0.01）。在 IBD 药物方面，5 年内使用美沙拉嗪的患者比例从 47%降至 71%（P <0.01），使用皮质类固醇的患者比例从 9%降至 32%（P = 0.02）。免疫抑制剂（抗 TNF 0%比 15%，P = 0.25；硫嘌呤 12%比 34%，P = 0.13）的使用也呈下降趋势。
癌症相关的化疗与 IBD 的更良性病程相关，这可能有助于决定在开始化疗之前停止与癌症相关治疗相关的抗 TNF 或其他免疫抑制剂，以及之后重新开始用于 IBD 的侵袭性免疫抑制剂。
