Advanced inflammatory bowel disease therapies in patients with recent solid malignancy: long-term outcomes in a propensity-matched cohort.

BACKGROUND

Managing inflammatory bowel disease (IBD) after recent malignancy requires balancing disease control against oncologic risk. We evaluated outcomes associated with advanced therapy in this population.

METHODS

We performed a TriNetX cohort study of adults with IBD and solid malignancy (colon, breast, lung, prostate, and melanoma). Advanced therapy included biologics or small molecules initiated within 5 years of cancer diagnosis. Propensity score matching accounted for demographics, IBD type, cancer type, and comorbidities. Outcomes were hospitalization, systemic steroid use, IBD-related surgery, opportunistic infection, and all-cause mortality. A 6-month landmark analysis classified exposure during the first 180 days with follow-up thereafter.

RESULTS

After matching, each group included 1116 patients. Hospitalization, steroid use, surgery, and opportunistic infections did not differ significantly in time-to-event analysis. Mortality occurred earlier with advanced therapy [hazard ratio: 1.578, 95% confidence interval (CI): 1.188-2.098; P = 0.002]. Landmark analysis (770 per group) showed that mortality (9.2 vs. 9.8%, risk ratio: 0.940, 95% CI: 0.689-1.282) and surgery (2.7 vs. 2.4%, risk ratio: 1.114, 95% CI: 0.594-2.089) were similar. Hospitalization (18.8 vs. 12.0%, risk ratio: 1.565), steroid use (55.1 vs. 30.1%; risk ratio: 1.833), and opportunistic infection (15.3 vs. 8.9%, risk ratio: 1.714) were higher with advanced therapy.

CONCLUSION

Advanced therapy was not associated with increased mortality after landmarking. Apparent benefits in primary analysis were not confirmed, suggesting immortal time bias and confounding by indication. Individualized multidisciplinary treatment remains appropriate.