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S1782 Assessing the Outcomes of AZA and MTX Use on Mortality and Skin Cancer Development in Patients With IBD
Abstract   Peer reviewed

S1782 Assessing the Outcomes of AZA and MTX Use on Mortality and Skin Cancer Development in Patients With IBD

M Housam Nanah, Varun Aitharaju, Ahmed Telbany and Joseph Sleiman
The American journal of gastroenterology, Vol.120(10S2), pp.S371-S371
10/01/2025
DOI: 10.14309/01.ajg.0001134588.47102.27

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Abstract

Introduction: Inflammatory bowel disease (IBD), has been linked with both melanoma and nonmelanoma skin cancers, particularly through the use of an immunosuppressant agent (IMM), azathioprine (AZA), with or without biologics. Many consider methotrexate (MTX) as an alternative, safer, immunosuppressive agent for combination therapy. However, some evidence in non-IBD autoimmune disorders suggests a similar skin cancer risk. This study investigates the relationship between AZA or MTX use and the incidence of melanoma, non melanoma skin cancers, and all-cause mortality in the IBD patient population. Methods: In this retrospective cross-sectional TriNetX database study, adult patients with ulcerative colitis (UC) and Crohn’s disease (CD) were identified using International Classification of Diseases-10 codes, and 4 cohorts were established: Patients with IBD on either MTX or AZA (IBD + IMM), those with no exposure to MTX or AZA (IBD-IMM), IBD patients with IBD only AZA exposure (IBD + AZA), and those with only MTX exposure (IBD + MTX). Propensity score matching (PSM) was performed based on baseline demographics, age, sex, and use of advanced IBD therapies. Results: PSM yielded 18,308 patients in both groups of IBD + IMM and IBD-IMM. Similarly, 7,749 patients were identified for comparing groups of IBD + AZA and IBD + MTX. Following PSM, IBD + IMM had lower odds of mortality (OR 0.725) and higher odds of nonmelanoma skin cancer (OR 1.22) compared to patients of IBD-IMM. IBD + AZA group had lower odds of mortality (OR 0.865) with higher odds of nonmelanoma skin cancer (OR 1.808) compared to patients with IBD + MTX. There was no difference in terms of Melanoma skin cancer between either 2 groups. Conclusion: In this large, real-world cross-sectional study, the use of IMMs in patients with IBD was associated with lower mortality odds at the risk of an increased risk of developing nonmelanoma skin cancer. Analysis comparing AZA to MTX showed similar findings with increased risk for developing nonmelanoma skin cancer in the AZA group, with no signal against either agent for melanoma. This might portray the balance between the benefits of disease control and IMM risk.
 Disease Inflammatory Bowel Disease Skin Cancer Melanoma Mortality

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