Anti-TNF Agents In Inflammatory Bowel Disease Linked to Small Increased Risk of Lymphoma Interview with:
Rosemary Dray-Spira, MD, PhD
Department of Epidemiology
French National Agency for Medicines and Health Products Safety (ANSM)
Saint-Denis, France What is the background for this study? What are the main findings?

Response: Anti-tumor necrosis factor (anti-TNF) agents are increasingly used for the management of inflammatory bowel diseases (IBD), either alone or in combination with thiopurines. Their clinical benefits have been largely assessed, however they may expose to potentially serious adverse effects. While an increased risk of lymphoma has been established with thiopurines, up to now such a risk of lymphoma remained uncertain with anti-TNF agents.

In this study based upon a large, nationwide cohort of 189,289 patients with IBD, the use of anti-TNF agents alone was found associated with a 2 to 3 fold increase in the risk of lymphoma, similarly to thiopurines alone. In addition, the combination of these two treatments was associated with a 6 fold increase in the risk of lymphoma, ie a higher risk than with each treatment used alone. Although these differences are statistically significant, the risk of lymphoma among patients exposed to anti-TNF agents is less than 1 case per 1000 person-years. What should clinicians and patients take away from your report?

Response: Among adults with inflammatory bowel disease, the use of anti-TNF agents, either alone or in combination with thiopurines, is associated with a small but statistically significant increased risk of lymphoma; and this risk is higher with combination therapy than with either of these treatments used alone. These findings, which need to be considered against the potential benefits of successful treatment of IBD, should inform decisions regarding benefits and risks of treatment. What recommendations do you have for future research as a result of this study?

Response: By examining a national database of patients with IBD over a 5.5 year period, this study included a large number of patients treated with anti-TNF agents, either alone or in combination with thiopurines, thus allowing to study the association of these treatments with lymphoma incidence. However, the duration of follow-up under combination therapy in the study was relatively short (8 months on average). Future studies with longer follow-up will be necessary to assess the risks of lymphoma associated with these therapies over longer follow-up. 

No disclosures Thank you for your contribution to the community.


Lemaitre M, Kirchgesner J, Rudnichi A, Carrat F, Zureik M, Carbonnel F, Dray-Spira R. Association Between Use of Thiopurines or Tumor Necrosis Factor Antagonists Alone or in Combination and Risk of Lymphoma in Patients With Inflammatory Bowel Disease. JAMA. 2017;318(17):1679–1686. doi:10.1001/jama.2017.16071

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 9, 2017 by Marie Benz MD FAAD