Immunosuppression was not associated with cancer recurrence in patients with autoimmune diseases who had previously diagnosed cancers.

Immunosuppressive drugs (including immunomodulators and anti-tumour necrosis factor agents) are used increasingly to treat autoimmune conditions, but the safety of immunosuppression in patients with histories of cancer has been questioned. To address this issue, researchers conducted a meta-analysis of observational studies involving patients with immune-mediated disorders and previous malignancies; patients who received immunosuppressive therapies (other than glucocorticoids) were compared with those who did not.

The analysis included 31 studies (24,000 patients with 86,000 patient-years of follow up), mainly involving patients with inflammatory bowel disease and rheumatoid arthritis. During a median follow up of 44 months, patients who received immunosuppressive agents did not have higher rates of cancer recurrence or new primary cancers than patients who did not receive those agents. The timing of immunosuppressive therapy in relation to prior cancers did not affect the results. There were no differences in cancer recurrence rates across types of immunomodulation/immunosuppression. 

Comment: This meta-analysis provides some reassurance for patients with prior cancers who require immunosuppressive therapy for inflammatory diseases. However, the analysis mainly included patients with inflammatory bowel disease and rheumatoid arthritis and did not include some of the newer immunomodulating agents. I would not withhold immunosuppressive therapies from patients with past histories of cancer when those treatments are required to control the autoimmune disorder. However, this issue will require ongoing monitoring given new agents and new indications for their use. Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

David J. Bjorkman, MD, MSPH(HSA), SM(Epid), Professor in the Division of Gastroenterology, Hepatology and Nutrition, University of Utah School of Medicine, Salt Lake City, USA.

Gupta A, et al. Risk of cancer recurrence in patients with immune-mediated diseases with use of immunosuppressive therapies: an updated systematic review and meta-analysis. Clin Gastroenterol Hepatol 2023 Aug 12; e-pub (https://doi.org/10.1016/j.cgh.2023.07.027).

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.