Objective Patients with IBD are at increased risk of acute arterial events. Antitumour necrosis factor (TNF) agents and thiopurines may, via their anti-inflammatory properties, lower the risk of acute arterial events. The aim of this study was to assess the impact of thiopurines and anti-TNFs on the risk of acute arterial events in patients with IBD.
Design Patients aged 18 years or older and affiliated to the French national health insurance with a diagnosis of IBD were followed up from 1 April 2010 until 31 December 2014. The risks of acute arterial events (including ischaemic heart disease, cerebrovascular disease and peripheral artery disease) were compared between thiopurines and anti-TNFs exposed and unexposed patients with marginal structural Cox proportional hazard models adjusting for baseline and time-varying demographics, medications, traditional cardiovascular risk factors, comorbidities and IBD disease activity.
Results Among 177 827 patients with IBD (96 111 (54%) women, mean age at cohort entry 46.2 years (SD 16.3), 90 205 (50.7%) with Crohn’s disease (CD)), 4145 incident acute arterial events occurred (incidence rates: 5.4 per 1000 person-years). Compared with unexposed patients, exposure to anti-TNFs (HR 0.79, 95% CI 0.66 to 0.95), but not to thiopurines (HR 0.93, 95% CI 0.82 to 1.05), was associated with a decreased risk of acute arterial events. The magnitude in risk reduction was highest in men with CD exposed to anti-TNFs (HR 0.54, 95% CI 0.40 to 0.72).
Conclusion Exposure to anti-TNFs is associated with a decreased risk of acute arterial events in patients with IBD, particularly in men with CD.
- inflammatory bowel disease
- cardiovascular disease
- ischeamic heart disease
- cerebrovascular disease
- peripheral arterial disease
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Collaborators Collaborators of the BERENICE study group are the following: Laurent Beaugerie, Anne-Marie Bouvier, Anne Buisson, Franck Carbonnel, Fabrice Carrat, Jacques Cosnes, Corinne Gower-Rousseau, Julien Kirchgesner, Alain Olympie, Laurent Peyrin-Biroulet, Jean-François Rahier, Frank Ruemmele, Michael Schwarzinger, Tabassome Simon, Yazdan Yazdanpanah.
Contributors JK: study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content and statistical analysis. NNA: study concept and design, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. FC: analysis and interpretation of data and critical revision of the manuscript for important intellectual content.TJ: study concept and design, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. LB: study concept and design, analysis and interpretation of data, drafting of the manuscript and study supervision.
Funding The BERENICE project is supported by grants from the French National Agency for Medicines and Health Products Safety (Agence Nationale de Sécurité du Médicament).
Competing interests LB has received consulting fees from Abbott; lecture fees from Abbott, Abbvie, MSD, Ferring Pharmaceuticals and Janssen; and research support from Abbott, Biocodex and Ferring Pharmaceuticals. JK, NNA, FC and TJ disclose no conflicts.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.