TY - JOUR
T1 - Risk of Recurrent Acute Arterial Events Associated With Thiopurines and Anti-Tumor Necrosis Factor in Inflammatory Bowel Diseases
AU - Dheyriat, Lucile
AU - Ward, Daniel
AU - Beaugerie, Laurent
AU - Jess, Tine
AU - Kirchgesner, Julien
N1 - Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.
PY - 2023/1
Y1 - 2023/1
N2 - Background & Aims: Patients with inflammatory bowel disease (IBD) are at increased risk of acute arterial events. Treatment with anti–tumor necrosis factor (anti-TNF) agents has been associated with a protective effect against the first occurrence of acute arterial events, but the impact of treatment with anti-TNF in patients with a previous history of acute arterial events remains unclear. We assessed the effect of anti-TNF and thiopurines on the risk of recurrent acute arterial events in patients with IBD in a nationwide cohort. Methods: Based on the French nationwide health insurance database, patients with IBD and a previous history of an acute arterial event were followed up from January 1, 2009, until December 31, 2018. The risk of acute arterial event recurrence associated with anti-TNF and thiopurine exposure was assessed using marginal structural Cox proportional hazard models adjusted for baseline and time-varying covariates. Results: A total of 27,185 patients were included. During 121,822 person-years (median follow-up period, 4.0 y), 6865 recurrent acute arterial events occurred (incidence rate per 1000 person-years, 56.4; 95% CI, 55.0–57.7). Exposure to both anti-TNF and thiopurines were associated with a decreased risk of recurrent acute arterial events compared with the absence of exposure to either treatment (hazard ratio, 0.75; 95% CI, 0.63–0.90 and hazard ratio, 0.76; 95% CI, 0.66–0.88, respectively). Conclusions: In a nationwide cohort study of patients with IBD and a previous history of an acute arterial event, exposure to both anti-TNF and thiopurines were associated with a decreased risk of recurrent acute arterial events.
AB - Background & Aims: Patients with inflammatory bowel disease (IBD) are at increased risk of acute arterial events. Treatment with anti–tumor necrosis factor (anti-TNF) agents has been associated with a protective effect against the first occurrence of acute arterial events, but the impact of treatment with anti-TNF in patients with a previous history of acute arterial events remains unclear. We assessed the effect of anti-TNF and thiopurines on the risk of recurrent acute arterial events in patients with IBD in a nationwide cohort. Methods: Based on the French nationwide health insurance database, patients with IBD and a previous history of an acute arterial event were followed up from January 1, 2009, until December 31, 2018. The risk of acute arterial event recurrence associated with anti-TNF and thiopurine exposure was assessed using marginal structural Cox proportional hazard models adjusted for baseline and time-varying covariates. Results: A total of 27,185 patients were included. During 121,822 person-years (median follow-up period, 4.0 y), 6865 recurrent acute arterial events occurred (incidence rate per 1000 person-years, 56.4; 95% CI, 55.0–57.7). Exposure to both anti-TNF and thiopurines were associated with a decreased risk of recurrent acute arterial events compared with the absence of exposure to either treatment (hazard ratio, 0.75; 95% CI, 0.63–0.90 and hazard ratio, 0.76; 95% CI, 0.66–0.88, respectively). Conclusions: In a nationwide cohort study of patients with IBD and a previous history of an acute arterial event, exposure to both anti-TNF and thiopurines were associated with a decreased risk of recurrent acute arterial events.
KW - Anti-TNF
KW - Cardiovascular Risk
KW - Inflammatory Bowel Disease
KW - Thiopurines
UR - http://www.scopus.com/inward/record.url?scp=85139369110&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2022.06.011
DO - 10.1016/j.cgh.2022.06.011
M3 - Journal article
C2 - 35842123
SN - 1542-3565
VL - 21
SP - 164-172.e11
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 1
ER -