Chemoprevention of colorectal neoplasia in ulcerative colitis

The effect of 6-mercaptopurine

Sierra Matula, Victoria Croog, Steven Itzkowitz, Noam Harpaz, Carol Bodian, Sabera Hossain, Thomas A. Ullman

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Background & Aims: Evidence suggests that mesalamine-based anti-inflammatory medicines may prevent colorectal cancer (CRC) in ulcerative colitis (UC). If mesalamine exerts its chemopreventive effect by its anti-inflammatory activity, then other medications that reduce colitis activity also should possess chemopreventive properties. Our aim was to determine the effect of the immunomodulators 6-mercaptopurine (6MP) and azathioprine (AZA) in preventing the development of dysplasia or CRC in UC. Methods: Patients with UC who underwent a surveillance colonoscopy in 1996-1997 were identified from a gastrointestinal pathology database. A proportional hazards analysis assessing 6MP/AZA use as a time-changing covariate was performed to evaluate the effect of 6MP/AZA on: (1) progression to any neoplasia (low-grade dysplasia, high-grade dysplasia, or CRC), and (2) progression to advanced neoplasia (high-grade dysplasia or CRC). Results: A total of 315 subjects met inclusion criteria and were followed for an average of 8 years from their first surveillance examination. There were no significant differences in rates of progression to advanced neoplasia or to any neoplasia between 6MP/AZA users and never-users by log-rank testing. The proportional hazards analysis resulted in hazard ratios of 1.06 (95% confidence interval, .59-1.93) and 1.30 (95% confidence interval, .45-3.75) when considering the effect of exposure to 6MP/AZA on progression to any or to advanced neoplasia, respectively. The results were unaffected by known potential confounders. Conclusions: In UC patients with no initial history of dysplasia, 6MP/AZA use appears to have little or no effect on the rate of neoplastic transformation in the colon. Importantly, the use of 6MP/AZA did not increase malignant transformation in UC.

Original languageEnglish (US)
Pages (from-to)1015-1021
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume3
Issue number10
DOIs
StatePublished - Oct 1 2005
Externally publishedYes

Fingerprint

6-Mercaptopurine
Chemoprevention
Azathioprine
Ulcerative Colitis
Colorectal Neoplasms
Neoplasms
Mesalamine
Anti-Inflammatory Agents
Confidence Intervals
Immunologic Factors
Colitis
Colonoscopy
Colon
Databases
Pathology

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Chemoprevention of colorectal neoplasia in ulcerative colitis : The effect of 6-mercaptopurine. / Matula, Sierra; Croog, Victoria; Itzkowitz, Steven; Harpaz, Noam; Bodian, Carol; Hossain, Sabera; Ullman, Thomas A.

In: Clinical Gastroenterology and Hepatology, Vol. 3, No. 10, 01.10.2005, p. 1015-1021.

Research output: Contribution to journalArticle

Matula, Sierra ; Croog, Victoria ; Itzkowitz, Steven ; Harpaz, Noam ; Bodian, Carol ; Hossain, Sabera ; Ullman, Thomas A. / Chemoprevention of colorectal neoplasia in ulcerative colitis : The effect of 6-mercaptopurine. In: Clinical Gastroenterology and Hepatology. 2005 ; Vol. 3, No. 10. pp. 1015-1021.
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