This research report applies specifically to long-term use of thiopurines, in older patients, but I have a hunch that when researchers get around to doing similar studies with other immune system suppressants, (especially the anti-TNF drugs), they will discover an even worse risk, and it will most likely include younger users. The thiopurines have been in use for many more years than the anti-TNF drugs, so long-term data is available for studies, (the anti-TNF drugs have only been on the market for about 11 or 12 years, whereas Imuran has been available for over 50 years). Note that statistically, this is still a very small risk, and shouldn't necessarily rule out any particular drug, since the benefits may justify the risk.
Statistical analysis showed that patients receiving thiopurines -- like azathioprine produced by several generic drugmakers and by GlaxoSmithKline (GSK.L) as Imuran -- had a more than five-fold increased risk of lymphoma compared with those who had never received the drugs, the researchers said in a study published in The Lancet journal.
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I'm not a doctor, of course, but IMO, Prednisone can sometimes work wonders, to "shock" an out-of-control digestive system into remission, in recalcitrant cases. Long-term use, though, (and for Pred, I consider anything longer than a couple of weeks, to border on long-term use), scares the heck out of me - it's too hard on the adrenals. There's nothing wrong with starting a treatment regimen with Prednisone, but IMO, it should be quickly phased out, and Entocort phased in, in order to minimize the risk of systemic damage. As far as I can tell, long-term use of Entocort EC, (especially at maintenance dose levels), seems to be pretty safe, due to it's minimal systemic absorption, and most comparison trials have shown it to be just as effective as Prednisone, for all practical purposes.
A lot of people view the anti-TNF drugs, such as Remicade, Humira, Embrel, etc., to be miracle drugs, (and they do bring spectacular relief, for many patients), but I think they should be left as an absolute last resort treatment, because the powerful effects they have on the immune system are not to be taken lightly. More and more reports of unintended consequences are showing up in FDA files, and they haven't been on the market for very many years.
These meds have been used for RA much longer than they have been prescribed for IBDs, and in some studies, the odds of developing lymphoma, lung cancer, and, (less commonly), non-melanoma skin cancer, seem to be significantly increased. Some authorities write those increased risks off, by claiming that RA in itself can cause cancer, but the three types of cancer that I listed, are rather rare in RA patients, when anti-TNF drugs are not used. I have also seen case studies where patients with cancer, stopped taking the drug, and the cancer stopped progressing. That's why anti-TNF drugs are contraindicated for anyone who has cancer, or who has had cancer in the past.
Since untreated gluten sensitivity leads to a heightened risk of lymphoma, in patients with celiac disease, or IBDs, then using these drugs to treat IBDs, may possibly exacerbate the lymphoma risk, in a synergistic fashion. The thing that disturbs me the most, I suppose, is the fact that drugs in this class are being prescribed more and more for younger patients, and the jury is still out on long-term consequences, since the drugs have only been used for a relatively short time, compared with a normal lifespan. IOW, no one knows what may happen 20, or 30, or 40 years from now, to patients who used these drugs at a young age. I have Parkinson's disease now, probably because of a herbicide that I used 25 or 30 years ago. When I used it, it was thought to be perfectly safe.
I don't mean to try to scare you, because statistically, very few people experience these adverse consequences from drugs of this type, so the odds are strongly in favor of the patient. If you happen to be one of those affected, though, it's a disastrous situation to be in, because the adverse events that they cause, are major, often fatal, issues. It's kind of like air travel - it's a great way to get somewhere in a hurry. If something goes seriously wrong, though, you're not likely to walk away from the resulting crash.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
