Siegel CA, Marden SM, Persing SM et al. Clin Gastroenterol Hepatol 2009;7:874–81.
Concerns have been raised that anti-tumor necrosis factor (anti-TNF) agents may increase the risk of non-Hodgkin’s lymphoma (NHL). These authors conducted a meta-analysis to determine the rate of NHL in adult Crohn’s disease patients treated with anti-TNFs, and compared this rate with that of a population-based registry and a population of immunomodulator-treated Crohn’s disease patients. They found the use of anti-TNF agents in conjunction with immunomodulators to be associated with an increased risk of NHL; however, they state that absolute rate of these events is low and should be weighed against the substantial benefits of treatment.
Crohn’s disease patients do not appear to have an increased risk of lymphoma, but Crohn’s disease patients treated with immunomodulators such as azathioprine and 6-mercaptopurine (6-MP) may have up to a four-fold increased risk. Crohn’s disease that is refractory to steroids and immunomodulator drugs requires the use of anti-tumor necrosis factor (anti-TNF) drugs (infliximab, adalimumab, and certolizumab pegol). The use of these therapies has resulted in concerns of a possible association with an increased risk of lymphoma, in particular of non-Hodgkin’s lymphoma (NHL; up to a 1.5% absolute annual risk).