SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2023 | VOLUME 21 | ISSUE 1 | 25 follow-up assessment and expedient dermatology referral if any suspicious lesions have been identified to facilitate early intervention. 1 The ongoing concerns related to the long term thiopurine use in IBD patients remains a valid one with numerous studies demonstrating an increased risk for NMSC which can be mitigated by diligent clinician- patient collaboration and astute pharmacovigilance aimed at early detection and modifying environmental risk factors. Financial Support: None declared Conflict of interest: None declared References 1. Thet Z, Lam AK, Ranganathan D, Aung SY, Han T and Khoo TK. Reducing non-melanoma skin cancer risk in renal transplant recipients . Nephrology. 2021;26:907–919. 2. Van Liere E, Bayoumy AB, Mulder CJJ, Warner B, Hayee B, Mateen BA, Nolan JD, De Boer NKH, Anderson SCH and Ansari AR. Azathioprine with Allopurinol Is a Promising First-Line Therapy for Infammatory Bowel Diseases . Digestive Diseases and Sciences (2022) 67:4008–4019. 3. Haung SZ, Lui ZC, Laio WX, Huang XW, Yang C, Xia YH, Li L, Ye C and Dai SX. Risk of skin cancers in thiopurines- treated and thiopurines-untreated patients with inflammatory bowel disease : A systematic review and meta-analysis. Journal of Gastroenterology and Hepatology 34 (2019) 507–516. 4. Setshedi M, Epstein D, Winter TA, Myer L, Watermeyer G and Hift R. Use of thiopurines in the treatment of inflammatory bowel disease is associated with an increased risk of non-melanoma skin cancer in an at-risk population: A cohort study . Journal of Gastroenterology and Hepatology 27 (2012) 385–389. 5. Chalastanis A, Penard-Lacronique V, Svrcek M, Defaweux V, Antoine N, Buhard O, Dumont S, Fabiani B, Renault I, Tubacher E, Fléjou JF, te Riele H, Duval A, Muleris M. Azathioprine-Induced Carcinogenesis in Mice According to Msh2 Genotype . Journal of National Cancer Institute. (2010); 102:1731–1740. 6. Zheng KYC , Guo CG, Wong IOL, Chen L, Chung HY, Cheung KS and Wai K. Leung. Risk of malignancies in patients with inflammatory bowel disease who used thiopurines as compared with other indications: a territory-wide study . Therapeutic Advances in Gastroenterology. (2020), Vol. 13: 1–12. 7. Long MD, Herfarth HH, Pipkin C, Porter CQ, Sandler RS, and Kappelman M. Increased Risk for Non-Melanoma Skin Cancer in Patients with Inflammatory Bowel Disease . Clinical Gastroenterology and Hepatology. (2010) March ; 8(3): 268–274. 8. Jiyad Z, Olsen CM, Burke MT, Isbel NM and Green AC. Azathioprine and Risk of Skin Cancer in Organ Transplant Recipients: Systematic Review and Meta- Analysis . American Journal of Transplantation (2016); 16: 3490–3503. 9. Wu Y, Ghaly S, Kerr S, Jackson B, Hanigan K, Martins D, Krishnaprasad K, Mountfield RE, Whiteman DC, Bampton PA, Gearry RB, Radford-Smith GL and Lawrence IC. Level of UV Exposure, Skin Type, and Age Are More Important than Thiopurine Use for Keratinocyte Carcinoma Development in IBD Patients . Digestive Diseases and Sciences (2020) 65:1172–1179. 10. Somazu S, Tanaka Y, Tamai M, Watanabe A, Kagami K, Abe M, Harama D, Shinohara T, Akahane K, Goi K, Sugita K, Moriyama T, Yang J, Goto H, Minegishi M, Iwamoto S, Takita J and Inukai T. NUDT15 polymorphism and NT5C2 and PRPS1 mutations influence thiopurine sensitivity in acute lymphoblastic leukaemia cells . Journal of Cellular and Molecular Medicine. (2021); 25:10521–10533. 11. Suiter CC, Moriyama T, Matreyek KA, Yanga W, Scaletti ER, Nishi R, Yang W, Hoshitsuki K, Singh M, Trehan A, Parish C, Smith C, Lia L, Bhojwani D, Yueng LYP, Lih C, Lii C, Yang Y, Walker GJ, Goodhand J, Kennedy NA, Klussman FA, Bhatia S, Relling MV, Kato M, Hori H, Bhatia P, Ahmad T, Yeo AEJ, Stenmark P, Fowler DM and Yanga JJ. Massively parallel variant characterization identifies NUDT15 alleles associated with thiopurine toxicity. Proceedings of the National Academy of Sciences of the United States of America, March 10, (2020), Vol. 117, No. 10 5394-5401 12. Yoshida M, Nakabayashi K, Sato-Otsubo A, Tsujimoto S, Yoshida K, Shirai R, Osumi T, Yuza Y, Takagi M, Takahashi H, Koh K, Kinoshita A, Hino M, Imamura T, Nakazawa Y, Mayuko O, Kakuda H, Sanada M, Matsumoto K, Tomizawa D, Kiyokawa N, Ohara A, Manabe A, Hata K, Yang JJ, Kato M. NUDT15 Variants Confer High Incidence of Secondary Malignancies of ALL in Children . Blood, (2019), Vol.134 (Supplement 1). 2751-275. 13. Nishi R, Moriyama T, Janke LJ, Yang W, Suiter CC, Lin TN, Li L, Kihira K, Toyoda H, Hofmann U, Schwab M, Takagi M, Morio T, Manabe T, Kham S, Jiang N, Rabin KR, Kato M, Koh K, Yeoh EJ, Hori H and Yang JJ. Preclinical evaluation of NUDT15-guided thiopurine therapy and its effects on toxicity and antileukemic efficacy . Blood. 2018;131(22):2466-2474) 14. Lange E, Blizzard L, Venn A, Francis H, Jones G. Disease modifying anti-rheumatic drugs and non-melanoma skin cancer in inflammatory arthritis patients: a retrospective cohort study . Rheumatology (Oxford). 2016;55(9):1594- 1600 15. Scott FI, Mamtani R, Brensinger CM, Haynes K,Chiesa- Fuxench ZC, Zhang J, Chen L, Xie F, Yun H, Osterman MT, Beukelman T, Margolis DJ, Curtis JR, Lewis and James D. Risk of Nonmelanoma Skin Cancer Associated With the Use of Immunosuppressant and Biologic Agents in Patients With a History of Autoimmune Disease and Nonmelanoma Skin Cancer . JAMA dermatology (Chicago, Ill.), 2016, Vol.152 (2), p.1-9 16. Ruolin L, Qianyi W, Rui Z, Haitao X, Ying C and Xuewen X. Risk of non-melanoma skin cancer with biological therapy in common infammatory diseases: a systemic review and meta-analysis. Cancer Cell International (2021) 21:614 17. Osterman MT, Sandborn WJ, Colombel JF, Robinson AM, Lau W, Huang B, Pollack PF, Thakkar RB, and Lewis JD. Increased risk of malignancy with adalimumab combination therapy, compared with monotherapy, for Crohn’s disease . Gastroenterology 2014;146:94 CASE REPORT