Joyce Wing Yan Mak1,2, Jacqueline So3, Whitney Tang1,2, Terry Cheuk Fung Yip1, Wai Keung Leung4, Michael Li5, Fu Hang Lo6, Ka Man Ng7, Shun Fung Sze8, Chi Man Leung9, Steven Woon Choy Tsang10, Edwin Hok Shing Shan11, Kam Hon Chan12, Belsy C Y Lam13, Aric J Hui14, Wai Hung Chow15, Francis Ka Leung Chan1,2, Siew Chien Ng1,2. 1. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, New Territories, Hong Kong. 2. Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, The Chinese University of Hong Kong, New Territories, Hong Kong. 3. Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong. 4. Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong. 5. Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong. 6. Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong. 7. Department of Medicine and Geriatrics, Princess Margaret Hospital, Lai King, Hong Kong. 8. Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong. 9. Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong. 10. Department of Medicine, Tseung Kwan O Hospital, Tseung Kwan, Hong Kong. 11. Department of Medicine and Geriatrics, Caritas Medical Centre, Sham Shui Po, Hong Kong. 12. Department of Medicine, North District Hospital, Sheung Shui, Hong Kong. 13. Department of Medicine and Geriatrics, Kwong Wah Hospital, Mongkok, Hong Kong. 14. Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Taipo, Hong Kong. 15. Department of Medicine, Yan Chai Hospital, Tsuen Wan, Hong Kong.
Abstract
Background and aim: Role of 5-aminosalicylic acid (5-ASA), statin and aspirin in reducing cancer risks in inflammatory bowel disease (IBD) remains controversial. We aimed to examine chemo-preventive effects of these drugs in all cancers in IBD in population-based setting. Methods: IBD patients diagnosed between 2000 and 2016 were identified from the Hong Kong IBD Registry and followed from IBD diagnosis until first cancer occurrence. Primary outcome was cancer development ≥6 months after IBD diagnosis. Adjusted hazard ratio (aHR) with 95% confidence interval (CI) was estimated with Cox proportional hazards model. Additional effects of statin and aspirin on chemoprevention were also assessed. Results: Amongst 2103 IBD patients (857 Crohn's disease, 1246 ulcerative colitis; mean age 40.0 ± 15.6; 60.3% male) with 16,856 person-years follow-up, 48 patients (2.3%) developed cancer. The 5-r, 10-r and 15-year (95% CI) cumulative incidence of cancer were 1% (0.6 - 1.5%), 2.8 (2.0 - 3.9%) and 4.8 (3.4 - 6.5%), respectively. Total 1891 (89.9%) and 222 (10.6%) patients have received one or more prescriptions of 5-ASA and statin respectively. In multivariable analysis adjusted for age, gender, smoking status, IBD type and use of other medications, use of 5-ASA or statin was not associated with a reduced risk of cancer development (5-ASA: aHR 1.22, 95% CI: 0.60-2.48, p = .593; statin: aHR 0.48, 95% CI: 0.14-1.59, p = .227). Adding aspirin was not associated with a lowered cancer risk (aHR 1.18, 95% CI: 0.32-4.35, p = .799). Conclusion: Use of 5-ASA was not associated with a lowered cancer risk in Chinese IBD patients. Addition of statin/aspirin provided no additional benefit.Key summaryInflammatory bowel diseases (IBD) including Crohn's disease and ulcerative colitis are associated with increased risk of both intestinal and extra- intestinal cancers.Various medications including 5-aminosalicylate acid (5-ASA), statins and aspirin have been studied for their chemoprevention effects. However, most studies focused on colorectal cancer only and showed conflicting evidence. No studies so far looked at the effects of these medications on all cancer development in IBD.The 5-, 10- and 15-year (95% confidence interval) cumulative incidence of cancer in Chinese IBD patients were 1 (0.6-1.5%), 2.8 (2.0-3.9%) and 4.8 (3.4-6.5%), respectively.Use of 5-ASA was not associated with a lowered cancer risk in Chinese IBD patients. Addition of statin/aspirin provided no additional benefit.
Background and aim: Role of 5-aminosalicylic acid (5-ASA), statin and aspirin in reducing cancer risks in inflammatory bowel disease (IBD) remains controversial. We aimed to examine chemo-preventive effects of these drugs in all cancers in IBD in population-based setting. Methods:IBDpatients diagnosed between 2000 and 2016 were identified from the Hong Kong IBD Registry and followed from IBD diagnosis until first cancer occurrence. Primary outcome was cancer development ≥6 months after IBD diagnosis. Adjusted hazard ratio (aHR) with 95% confidence interval (CI) was estimated with Cox proportional hazards model. Additional effects of statin and aspirin on chemoprevention were also assessed. Results: Amongst 2103 IBDpatients (857 Crohn's disease, 1246 ulcerative colitis; mean age 40.0 ± 15.6; 60.3% male) with 16,856 person-years follow-up, 48 patients (2.3%) developed cancer. The 5-r, 10-r and 15-year (95% CI) cumulative incidence of cancer were 1% (0.6 - 1.5%), 2.8 (2.0 - 3.9%) and 4.8 (3.4 - 6.5%), respectively. Total 1891 (89.9%) and 222 (10.6%) patients have received one or more prescriptions of 5-ASA and statin respectively. In multivariable analysis adjusted for age, gender, smoking status, IBD type and use of other medications, use of 5-ASA or statin was not associated with a reduced risk of cancer development (5-ASA: aHR 1.22, 95% CI: 0.60-2.48, p = .593; statin: aHR 0.48, 95% CI: 0.14-1.59, p = .227). Adding aspirin was not associated with a lowered cancer risk (aHR 1.18, 95% CI: 0.32-4.35, p = .799). Conclusion: Use of 5-ASA was not associated with a lowered cancer risk in Chinese IBDpatients. Addition of statin/aspirin provided no additional benefit.Key summaryInflammatory bowel diseases (IBD) including Crohn's disease and ulcerative colitis are associated with increased risk of both intestinal and extra- intestinal cancers.Various medications including 5-aminosalicylate acid (5-ASA), statins and aspirin have been studied for their chemoprevention effects. However, most studies focused on colorectal cancer only and showed conflicting evidence. No studies so far looked at the effects of these medications on all cancer development in IBD.The 5-, 10- and 15-year (95% confidence interval) cumulative incidence of cancer in Chinese IBDpatients were 1 (0.6-1.5%), 2.8 (2.0-3.9%) and 4.8 (3.4-6.5%), respectively.Use of 5-ASA was not associated with a lowered cancer risk in Chinese IBDpatients. Addition of statin/aspirin provided no additional benefit.