Anti‐TNF-α Therapy May Increase Risk of Inflammatory Bowel Disease

Individuals with an autoimmune disease who receive treatment with etanercept have an increased risk of developing Crohn disease (CD) and ulcerative colitis (UC) while on treatment, according to the results of a new study.

Anti‐tumor necrosis factor α (anti‐TNF-α) medications are used in the management of numerous chronic inflammatory diseases including rheumatoid arthritis and ankylosing spondylitis. However, adverse effects have been reported with use, including de novo inflammatory bowel disease (IBD).

To analyze the relationship between the use of anti-TNF-α medications and the development of IBD, the researchers studied data from Danish health registries on 17,018 individuals with autoimmune diseases who were treated with at least 1 dose of an anti‐TNF-α agent and 63,308 participants who were not treated with an anti-TNF-α agent.

Most of the individuals who received treatment with an anti-TNF-α agent received infliximab, etanercept, or adalimumab.

The researchers recorded cases of de novo IBD from 2004 through 2017.

Results indicated that individuals who had received treatment with etanercept had a twofold increased risk of being diagnosed with CD (adjusted hazard ratio [HR], 2.0; 95% CI, 1.4‐2.8) and UC (adjusted HR, 2.0; 95% CI, 1.5‐2.8) while they received treatment.

Infliximab and adalimumab were not associated with an increased risk of de novo IBD.

“The nature of this association is uncertain,” the researchers concluded. “This finding has relevance to clinical care and insights into common mechanisms of the pathophysiology of these diseases.”

—Colleen Murphy

Reference:

Korzenik J, Larsen MD, Nielsen J, Kjeldsen J, Nørgård BM. Increased risk of developing Crohn’s disease or ulcerative colitis in 17 018 patients while under treatment with anti‐TNFα agents, particularly etanercept, for autoimmune diseases other than inflammatory bowel disease [published online July 2, 2019]. Aliment Pharmacol Ther. doi:10.1111/apt.15370.