Am J Gastroenterol. 2022 Oct 10. doi: 10.14309/ajg.0000000000002053. Online ahead of print.

Matthew D Egberg ^1 2, Xian Zhang ¹, Andrew B Smitherman ^3 4, Michael D Kappelman ^1 2

Author information

¹Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC.

²Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC.

³Department of Pediatrics, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC.

⁴Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Abstract

Introduction: Despite the effectiveness of immune suppressing therapies in treating pediatric inflammatory bowel diseases (IBD), concerns of lymphoma may limit their use. We used a large administrative claims database to evaluate the risk of lymphoma in pediatric IBD and conducted a case series analysis of medication exposure in children diagnosed with lymphoma.

Methods: We analyzed administrative claims from the 2007-2018 IQVIA database and identified pediatric (≤18 years) patients with Crohn's disease (CD), or ulcerative colitis (UC) using ICD-9/10 codes and pharmacy claims. Lymphoma cases were identified by diagnosis codes and confirmed by independent, claim-by-claim review by a pediatric oncologist and gastroenterologist. We calculated incidence rates (IR) for lymphoma among patients with and without pharmacy claims for treatment followed by treatment description among those who developed lymphoma during follow-up.

Results: A total of 10,777 pediatric IBD patients received ≥1 IBD therapy (median age 15 years (12,17), 45% female and 61% diagnosed with CD) during 28,292 patient-years of follow up. Among treated patients, five lymphoma cases were identified (IR 17.7/100,000 patient-years; 95% CI 6.5, 39.2). Of these, 4 four were treated with a thiopurine prior to lymphoma diagnosis and none received anti-TNF monotherapy.

Conclusion: The overall lymphoma incidence was low among our cohort of treated pediatric IBD patients. We observed no cases of lymphoma among patients prescribed anti-TNF monotherapy. These findings reinforce the relative safety of anti-TNF monotherapy for the treatment of pediatric IBD.