{
  "abstract": "Objective The incidence of colorectal cancer (CRC) remains elevated in the inflammatory bowel disease (IBD) population. We aimed to examine the association of biologics, 5-aminosalicylates (5-ASAs) and immunomodulators with the risk of CRC and/or dysplasia (CRC/Dys) in different IBD phenotypes.Methods We searched Web of Science, PubMed, MEDLINE and EMBASE from inception to 15 March 2025 for all studies assessing the association of biologics, 5-ASAs and immunomodulators on the occurrence of CRC/Dys in adults (≥16 years) with IBD. No randomised controlled trials were identified. Data were pooled using a random effects model generating relative risk (RR) estimates.Results Fifty observational studies containing 29 325 cases of CRC/Dys in 1 434 939 patients with IBD were included. Biologic therapies (RR 0.74; 95% CI 0.64 to 0.85, I 2=56.8%) and 5-ASAs (RR 0.78; 95% CI 0.70 to 0.86, I2=52.1%) were associated with a reduced risk of CRC/Dys in patients with IBD. Immunomodulators were not associated with a reduced risk (RR 0.92; 95% CI 0.82 to 1.02, I2=82.7%). After stratification for IBD phenotypes, medication subgroups and CRC outcome, anti-tumour necrosis factor (anti-TNF) therapies were associated with a reduced risk of CRC in patients with ulcerative colitis (RR 0.78; 95% CI 0.73 to 0.83, I2=0%) but not in Crohn’s disease. Non-sulfasalazine 5-ASAs were associated with a reduced risk of CRC in ulcerative colitis (RR 0.66; 95% CI 0.45 to 0.96, I2=75.4%) and Crohn’s disease (RR 0.84; 95% CI 0.81 to 0.87, I2=41.9%).Conclusion Use of anti-TNF biologics or non-sulfasalazine 5-ASAs is associated with a reduction in CRC risk in IBD, with differential effects by IBD phenotype.PROSPERO registration number CRD42024559501.",
  "authors": [
    {
      "affiliations": [
        "Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK",
        "Edinburgh Inflammatory Bowel Diseases Unit, Western General Hospital, Edinburgh, UK"
      ],
      "name": "Amirhosein Kefayat"
    },
    {
      "affiliations": [
        "School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK",
        "Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow , UK"
      ],
      "name": "Ross J Porter"
    },
    {
      "affiliations": [
        "Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK",
        "Edinburgh Inflammatory Bowel Diseases Unit, Western General Hospital, Edinburgh, UK"
      ],
      "name": "Antonia MD Churchhouse"
    },
    {
      "affiliations": [
        "Edinburgh Inflammatory Bowel Diseases Unit, Western General Hospital, Edinburgh, UK"
      ],
      "name": "Jonathan Blackwell"
    },
    {
      "affiliations": [
        "Edinburgh Inflammatory Bowel Diseases Unit, Western General Hospital, Edinburgh, UK"
      ],
      "name": "Eleanor F Watson"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow , UK"
      ],
      "name": "Allan John Morris"
    },
    {
      "affiliations": [
        "School of Medicine, University of Central Lancashire, Preston, Lancashire, UK"
      ],
      "name": "Morris Gordon"
    },
    {
      "affiliations": [
        "Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK"
      ],
      "name": "Gaurav B Nigam"
    },
    {
      "affiliations": [
        "Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK"
      ],
      "name": "James E East"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK",
        "Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK"
      ],
      "name": "Matthew D Rutter"
    },
    {
      "affiliations": [
        "Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK",
        "Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK"
      ],
      "name": "Christopher A Lamb"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK"
      ],
      "name": "Tim Raine"
    },
    {
      "affiliations": [
        "Leeds Gastroenterology Institute, St. James’s University Hospital, Leeds, UK",
        "Leeds Institute of Medical Research at St. James’s, University of Leeds, Leeds, UK"
      ],
      "name": "Alexander C Ford"
    },
    {
      "affiliations": [
        "Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK",
        "Edinburgh Inflammatory Bowel Diseases Unit, Western General Hospital, Edinburgh, UK"
      ],
      "name": "Shahida Din"
    }
  ],
  "title": "Reduced risk of colorectal cancer with non-sulfasalazine 5-ASAs in ulcerative colitis and Crohn’s disease and anti-TNF therapy in ulcerative colitis: a systematic review and meta-analysis",
  "uid": "81f8047a-d9ec-5b28-9722-b3dad29455de"
}