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Thiopurines prevent advanced colorectal neoplasia in patients with inflammatory bowel disease
  1. Fiona D M van Schaik1,
  2. Martijn G H van Oijen1,
  3. Hugo M Smeets2,3,
  4. Geert J M G van der Heijden2,
  5. Peter D Siersema1,
  6. Bas Oldenburg1
  1. 1Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3Agis Health Insurance, Amersfoort, The Netherlands
  1. Correspondence to Bas Oldenburg, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; b.oldenburg{at}


Background and aims Previous studies have suggested a chemopreventive effect of 5-aminosalicylic acid (5-ASA) therapy in patients with inflammatory bowel disease (IBD). This effect has not been reported in IBD patients using thiopurines. We investigated the association between thiopurine or 5-ASA use and the risk of advanced neoplasia (AN), including high-grade dysplasia and colorectal cancer, in a large cohort of patients with IBD in the Netherlands.

Methods PALGA, the nationwide network and registry of histo- and cytopathology in The Netherlands was linked to an anonymised computerised database of a Dutch health insurance company to identify patients with IBD with or without AN. Pharmaceutical data, including type and duration of medication use, were collected between January 2001 and December 2009. Cox proportional hazard regression analysis was used to calculate risk of AN in patients with and without thiopurine or 5-ASA use.

Results A total of 2578 patients with IBD were included. Of these, 973 patients (38%) used 5-ASA, 314 (12%) thiopurines, 456 (18%) both 5-ASA and thiopurines and 835 (32%) none of these drugs. Twenty-eight patients (1%) developed AN during 16 289 person-years of follow-up. Of these, 11 patients (39%) had used 5-ASA, two (7%) thiopurines and one (4%) both drugs. Thiopurine use was associated with a significantly decreased risk of developing AN (adjusted HR 0.10, 95% CI 0.01 to 0.75). 5-ASA therapy also had a protective effect on developing AN, but this was not statistically significant (adjusted HR 0.56, 95% CI 0.22 to 1.40).

Conclusion Thiopurine use protects IBD patients against the development of AN. The effect of 5-ASA appeared to be less pronounced.

  • Inflammatory bowel disease
  • colorectal neoplasia
  • 5-ASA
  • thiopurines

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  • Funding The study was supported by an unrestricted grant from Tramedico Holding B.V., PO Box 1451380 AC WEESP, The Netherlands.

  • Competing interests None.

  • Ethics approval This study was carried out with the approval of and in accordance with the privacy and ethical guidelines of the privacy committee of PALGA and the research committee of the Agis Health Database.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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