Systematic review with meta-analysis: thiopurines decrease the risk of colorectal neoplasia in patients with inflammatory bowel disease.

Abstract

Patients with inflammatory bowel disease (IBD) have a high risk of developing colorectal neoplasia. To investigate whether thiopurines can decrease the risk of developing colorectal neoplasia in patients with ulcerative colitis (UC) or Crohn's disease (CD). We conducted a meta-analysis of 24 observational studies involving 76,999 participants to evaluate the risks of developing colorectal neoplasia in IBD patients receiving thiopurine treatment. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the risks of colorectal neoplasia were calculated using a random-effects model. The overall pooled estimate revealed a protective effect of thiopurine use on colorectal neoplasia in patients with IBD (OR=0.63, 95% CI 0.46-0.86). The effect was significant in UC patients (OR=0.67, 95% CI 0.45-0.98), but was not significant in CD patients (OR=1.06, 95% CI 0.54-2.09). Thiopurines exposure significantly decreased the risk of colorectal cancer (CRC) (OR=0.65, 95% CI 0.45-0.96) and advanced colorectal neoplasia (CRC and/or high-grade dysplasia) (OR=0.62, 95% CI 0.44-0.89), but did not decrease the risk of dysplasia alone (OR=0.90, 95% CI 0.37-2.21). Tendencies towards the protective effect of thiopurines were distinct in clinic-based studies (OR=0.59, 95% CI 0.42-0.82) and case-control studies (OR=0.40, 95% CI 0.26-0.62), but not in population-based studies (OR=0.95, 95% CI 0.55-1.62) and cohort studies (OR=0.98, 95% CI 0.81-1.18). Interestingly, studies conducted in Europe (OR=0.48, 95% CI 0.31-0.77), rather than in North America (OR=0.91, 95% CI 0.67-1.24), showed the protective effect of thiopurines. This meta-analysis revealed an antineoplastic effect of thiopurines on colorectal neoplasia in patients with IBD, particularly amongst patients with UC.