Faculty mentor/PI email address
Yschneid@virtua.org
Is your research Teaching and Learning based?
1
Keywords
Colorectal Cancer, IBD, Crohns, Ulcerative Colitis, Infliximab, Ustekinumab, Vedolizumab
Date of Presentation
5-6-2026 12:00 AM
Poster Abstract
Background: Inflammatory bowel disease (IBD) confers elevated colorectal cancer (CRC) risk, but comparative long-term neoplastic risks between anti-TNF and gut-selective or IL-12/23–targeted biologics remain incompletely defined. We evaluated 5-year risks of CRC and GI neoplasia in IBD patients treated with infliximab versus vedolizumab and ustekinumab.
Methods: Using the TriNetX federated research network, two parallel 5-year propensity score–matched cohort analyses were conducted among adults with Crohn's disease or ulcerative colitis initiating infliximab, vedolizumab, or ustekinumab between 2018–2024. Patients with prior CRC, colectomy, or baseline comparator biologic exposure were excluded. The infliximab–vedolizumab analysis matched 13,111 patients per cohort; the infliximab–ustekinumab analysis matched 14,232 per cohort. Primary outcomes were incident CRC, other GI cancers, and colon polyps. Secondary outcomes included colectomy, GI dysplasia, and all-cause mortality. Five-year cumulative risks, risk ratios (RR), risk differences (RD), and hazard ratios (HR) were estimated.
Results: CRC incidence was low and statistically similar across all three biologics (infliximab vs. vedolizumab: 2.17% vs. 2.21%, RR 0.98, p=0.80; infliximab vs. ustekinumab: 0.37% vs. 0.54%, HR 0.78, p=0.30). Infliximab was associated with fewer other GI cancers (0.49% vs. 0.70%; RR 0.70, p=0.025) and colon polyps (9.34% vs. 10.31%; RR 0.91, p=0.008) versus vedolizumab. Colectomy rates were higher with infliximab than vedolizumab (RR 1.48, p=0.003). Neoplastic outcomes were broadly comparable between infliximab and ustekinumab. Mortality was low across all groups.
Conclusions: All three biologics demonstrated similarly low CRC risk in IBD. Infliximab showed modest advantages over vedolizumab in GI neoplasia but higher colectomy rates. Prospective studies are warranted to confirm these class-specific differences.
Disciplines
Digestive System Diseases | Medicine and Health Sciences | Neoplasms
Included in
RISK OF COLORECTAL AND GASTROINTESTINAL NEOPLASIA IN INFLAMMATORY BOWEL DISEASE TREATED WITH INFLIXIMAB VERSUS VEDOLIZUMAB AND USTEKINUMAB: A 5-YEAR MULTICENTER RETROSPECTIVE COHORT STUDY
Background: Inflammatory bowel disease (IBD) confers elevated colorectal cancer (CRC) risk, but comparative long-term neoplastic risks between anti-TNF and gut-selective or IL-12/23–targeted biologics remain incompletely defined. We evaluated 5-year risks of CRC and GI neoplasia in IBD patients treated with infliximab versus vedolizumab and ustekinumab.
Methods: Using the TriNetX federated research network, two parallel 5-year propensity score–matched cohort analyses were conducted among adults with Crohn's disease or ulcerative colitis initiating infliximab, vedolizumab, or ustekinumab between 2018–2024. Patients with prior CRC, colectomy, or baseline comparator biologic exposure were excluded. The infliximab–vedolizumab analysis matched 13,111 patients per cohort; the infliximab–ustekinumab analysis matched 14,232 per cohort. Primary outcomes were incident CRC, other GI cancers, and colon polyps. Secondary outcomes included colectomy, GI dysplasia, and all-cause mortality. Five-year cumulative risks, risk ratios (RR), risk differences (RD), and hazard ratios (HR) were estimated.
Results: CRC incidence was low and statistically similar across all three biologics (infliximab vs. vedolizumab: 2.17% vs. 2.21%, RR 0.98, p=0.80; infliximab vs. ustekinumab: 0.37% vs. 0.54%, HR 0.78, p=0.30). Infliximab was associated with fewer other GI cancers (0.49% vs. 0.70%; RR 0.70, p=0.025) and colon polyps (9.34% vs. 10.31%; RR 0.91, p=0.008) versus vedolizumab. Colectomy rates were higher with infliximab than vedolizumab (RR 1.48, p=0.003). Neoplastic outcomes were broadly comparable between infliximab and ustekinumab. Mortality was low across all groups.
Conclusions: All three biologics demonstrated similarly low CRC risk in IBD. Infliximab showed modest advantages over vedolizumab in GI neoplasia but higher colectomy rates. Prospective studies are warranted to confirm these class-specific differences.