Absolute risk of malignancy by treatment in patients with Crohn's disease compared to the general population: a nationwide population-based cohort study.

Authors

Åsa H Everhov, Julia Eriksson, Jonas Söderling, Johan Askling, Jonas Halfvarson, Karin E Smedby, Jonas F Ludvigsson, Henrik Toft Sørensen, Ola Olén, SWIBREG study group

Published in

The American journal of gastroenterology. Jul 16, 2026. Epub Jul 16, 2026.

Abstract

Real-world data quantifying absolute cancer risk in Crohn's disease (CD) by treatment status are lacking but are essential for patient counselling.
We linked nationwide Swedish register data and assessed incident cancers overall and by type in patients with CD 2007-2023. We estimated age-stratified incidence rate (IR) differences compared to the general population in a "once-exposed-always-exposed" design. Treatment cohorts comprised new users of thiopurine, tumor necrosis factor inhibitors (TNFi), thiopurine+TNFi, vedolizumab, ustekinumab, and patients naïve to immunomodulatory drugs.
We followed 38,733 patients and 360,616 comparator subjects for a median 7.3 years. The IR differences for any cancer (number of excess cancers in each treatment cohort per 1,000 person-years versus the matched population) were 2.43 (95%CI:1.92;2.94) for the naive cohort; 3.14 (95%CI:2.50;3.78) for thiopurine-treated, 2.42 (95%CI:1.63;3.22) for TNFi-treated, 2.59 (95%CI:1.53;3.64) for thiopurine +TNFi, 2.61 (95%CI:-0.08;5.30) for vedolizumab, and 1.54 (95%CI:-1.34;4.41) for ustekinumab. The excess cancer incidence was primarily due to non-melanoma skin cancer (squamous cell and basal cell carcinoma). After exclusion of non-melanoma skin cancers, the excess overall cancer incidence was 1.27 to 0.96 cases/1,000 person-years in the naïve, thiopurine, and TNFi-treated groups, but not significantly increased in the other. IR differences for overall cancer increased and HRs decreased with increasing patient age.
Elevated overall cancer incidence was observed across all treatment cohorts, also in treatment-naïve patients. After exclusion of non-melanoma skin cancer, the excess cancer incidence in CD was around 1 extra case per 1,000 person-years due to lung-, small bowel -, hepatobiliary, and hematologic cancer.

PMID:
42467952
Bibliographic data and abstract were imported from PubMed on 18 Jul 2026.

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