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Meta-Analysis
. 2013 Nov 28;8(11):e81487.
doi: 10.1371/journal.pone.0081487. eCollection 2013.

Use of thiopurines and risk of colorectal neoplasia in patients with inflammatory bowel diseases: a meta-analysis

Jianfeng Gong  1 , Lijing Zhu, Zhen Guo, Yi Li, Weiming Zhu, Ning Li, Jieshou Li
Affiliations
Meta-Analysis

Use of thiopurines and risk of colorectal neoplasia in patients with inflammatory bowel diseases: a meta-analysis

Jianfeng Gong et al. PLoS One. .

Abstract

Objective: Inflammatory bowel disease (IBD) is commonly treated with thiopurines such as azathioprine and mercaptopurine for the maintenance of remission. Studies examining chemopreventive of these medications on colorectal neoplasm in IBD patients have yielded conflicting results. We performed a meta-analysis to assess the role of thiopurines for this indication.

Methods: We performed a systematic search of PubMed, Web of Science, EMBASE and Cochrane to identify studies reporting colorectal neoplasm from IBD patients treated with thiopurines and conducted a meta-analysis of pooled relative risk (RR) using the random effects model.

Results: Nine case-control and ten cohort studies fulfilled the inclusion criteria. The use of thiopurines was associated with a statistically significant decreased incidence of colorectal neoplasm (summary RR=0.71, 95% CI=0.54-0.94, p=0.017), even after adjustment for duration and extent of the disease, but there was high heterogeneity among studies (I(2)=68.0%, p<0.001). The RR of advanced neoplasm (high-grade dysplasia and cancer) was 0.72 (95%CI=0.50-1.03, p=0.070) and that of cancer was 0.70 (95% CI=0.46-1.09, p=0.111) for thiopurine-treated patients. Heterogeneity of the studies was affected by the sample size (</≥ 100 cases) and whether the patients had longstanding colitis (≥ 7 years).

Conclusion: The current meta-analysis revealed that thiopurines had a chemopreventive effect of colorectal neoplasms and a tendency of reducing advanced colorectal neoplasms in IBD. Due to the heterogeneity of included studies, these results should be interpreted with caution.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Search and study selection process.
Figure 2
Figure 2. Association between thiopurine use and colorectal neoplasm risk in nine case-control and ten cohort studies.
Random effects models were used as there were statistical heterogeneity across studies (I 2=68.0%, P <0.001). Usage of thiopurine is associated with decreased incidence of colorectal neoplasm in IBD patients (RR=0.71, 95% CI=0.54-0.94, P=0.017). RR: relative risk. CI: confidence interval.
Figure 3
Figure 3. Funnel plots for overall studies.
The shapes of the funnel plots did not reveal any evidence of obvious asymmetry visually. se: standard error; RR: Relative risk.
See this image and copyright information in PMC

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