P-125 Increased Cervical Dysplasia in Women with Inflammatory Bowel Disease is Not Affected by the Type of Immunomodulating Agent

Abstract

Women with inflammatory bowel disease are at increased risk for the development of cervical dysplasia. The use of immunomodulating medication is reported to be a significant risk factor for the development of cervical abnormalities. However, it is uncertain if different categories of immunomodulating agents are associated with different rates of abnormal Pap smears. This study evaluated the rate of abnormal Pap smears in women with inflammatory bowel disease who are maintained on immunosuppressants and Tumor Necrosis Factor alpha (TNF-a). A retrospective medical record review of women with inflammatory bowel disease maintained on immunomodulating medication at an urban, university medical center during a 1.5 year period was performed using a multispecialty electronic health record. There were no exclusion factors. Patient age, medication regimen, and Pap smear results were obtained. Medical regimens were categorized into immunosuppressants (steroids, 6-mercaptopurine, azathioprine, methotrexate, cyclosporine) and TNF-a (infliximab, adalimumab, and certolizumab). Pap smears were considered abnormal if there was positivity for human papilloma virus or cervical dysplasia. A database, maintaining patient confidentiality, was created. Statistical analysis was performed using Fisher Exact Test with significance set at P < 0.05. The study was approved by the university Institutional Review Board. Two hundred eight medical records were reviewed. One hundred women (mean age 37.6 years) were on immunomodulating therapy. Sixty-three women had Crohn’s disease, 36 had ulcerative colitis and 1 had indeterminate colitis. Sixty-six women (39 with Crohn’s, 27 with ulcerative colitis) were maintained on immunosuppressants. Thirty-four women (24 with Crohn’s, 10 with ulcerative colitis) were maintained on TNF-a. Twenty-seven of 66 (41%) women were on immunosuppressants and 21 of 34 (61.7%) on TNF-a had documented Pap smears. There was a significant difference (P = 0.0385) in the rate of Pap smears based upon medication type. Five of the 27 (18.5%) on immunosuppressants had abnormal Pap smears. Eight of the 21(38.1%) on TNF-a had abnormal Pap smears. There was no significant difference (P = 0.1179) in the rate of cervical dysplasia based upon medication type. Women with inflammatory bowel disease who are maintained on immunosuppressants have a greater rate of cervical dysplasia than the 5% reported in the general population. This is the only study that has evaluated the effect of specific categories of immunomodulating agents upon the development of cervical abnormalities. In this study, women maintained on TNF-a more frequently underwent Pap smears. This may be the result of a greater appreciation by women on TNF-a agents and their physicians of the increased cervical cancer risk. However, there was no significant difference in the rate of abnormal Pap smears based upon the use of immunosuppressants or TNF-a medication. More needs to be done to increase cervical cancer screening in women with inflammatory bowel disease maintained on immunomodulating agents. Continued education of physicians and patients may increase the rate of Pap smears and optimize medical management of women with inflammatory bowel disease.