Anti-TNFs & IBD-related arterial disease

June 16, 2020

Issue 12

Clinical Question

Do anti-TNFs and thiopurines offer equal protection against arterial disease in IBD?

Editor’s Bottom Line

Anti-TNF therapies may be associated with a reduced risk of acute arterial events among patients with IBD. It remains to be determined whether this reflects their mechanism of action, control of disease activity or other confounding factors.

Reference

Kirchgesner J, Andersen NN, Carrat F, et al. Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study. Gut. 2020;69(5):852–58; https://gut.bmj.com/content/69/5/852.long

Synopsis

Previous research has found that IBD is linked with a higher risk of acute cardiovascular disease and that this risk relates to IBD activity. To determine whether thiopurines and anti-tumor necrosis factor (TNF) drugs mitigate this risk, researchers examined data from 177,827 patients with IBD registered in the French National Health Insurance Database between April 2010 and December 2014. Fifty-four percent were female, the mean age at the time of entry into the registry was 46.2 years and the median follow-up was 3.4 years. There was roughly an even split of Crohn’s disease (CD) and ulcerative colitis (UC) patients. Approximately 25% had been exposed to thiopurines during their disease course, 14.9% had received anti-TNF drugs, and 4.2% had undergone combination treatment with anti-TNFs and thiopurines.

Data revealed 4,145 acute arterial events during the follow-up period, of which 52% were ischemic cardiac events, 32% were cerebrovascular events and 16% were peripheral vascular events. More than 64% of those with an acute arterial event were male, 55% had UC and the mean age at time of first event was 62.3 years.

Those treated with an anti-TNF drug were 31% less likely to experience an acute arterial event than those who had never received an anti-TNF (Hazard Ratio [HR]: 0.79; 95% Confidence Interval [CI], 0.66–0.95). Thiopurine use was not associated with a lower risk, compared to those who had not used thiopurines (HR: 0.93; 95% CI, 0.82–1.05). Combination treatment with anti-TNF agents and thiopurines also did not reduce the risk. The protective effect of anti-TNFs was greatest among men with CD, compared to men with CD who had never received an anti-TNF (HR: 0.54; 95% CI, 0.40–0.72).

Details

Study Design: Retrospective cohort
Funding: The study received funding from the French National Agency for Medicines and Health Products Safety
Allocation: Not applicable
Setting: National prospective database
Level of Evidence: 2b (Oxford Levels of Evidence)