Anti-IL-17a treatment triples IBD risk with other chronic autoimmune diseases

  • Emond B & al.
  • Curr Med Res Opin
  • 06/06/2019

  • Debra Gordon
  • Clinical Essentials
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Takeaway

  • Anti-IL-17a treatment is associated with an almost 3-fold increased risk for IBD in patients with other chronic inflammatory diseases (CIDs).

Why this matters

  • Patients with CIDs have an increased risk of developing IBD and vice versa.
  • Evidence suggests that some biologic treatments used to manage the diseases may increase the risk for concomitant IBD in patients with CIDs (or vice versa).

Key results

  • After 1-year follow-up, ORs for IBD:
    • 2.85 (P=.0213) and 1.42 (P=.1891) in IL-17a and phosphodiesterase 4 inhibitor (PDE4i) cohorts, respectively, vs biologic-naive cohort; and
    • 2.86 (P=.0253) and 1.21 (P=.4978) in IL-17a and PDE4i cohorts, respectively, vs non-IBD-indicated biologic cohort.

Study design

  • Data from MarketScan Research Databases, used to develop a CID population of patients with ankylosing spondylitis, psoriatic arthritis, psoriasis, rheumatoid arthritis.
  • Stratified by treatment: IL-17a (n=355), PDE4i (n=2195), biologic-naive (n=424,767), non-IBD-indicated biologic (n=56,317).
  • Non-CID cohort also created (n=1,008,436).
  • Outcome: 1-year IBD incidence.
  • Funding: Janssen Scientific Affairs, LLC.

Limitations

  • Did not differentiate new-onset IBD and exacerbations of preexisting, potentially asymptomatic IBD.
  • Confounding cannot be ruled out.
  • Covered only commercially insured patients.
  • Conducted under intent-to-treat assumption; patients may have switched/discontinued treatment or used add-on/concomitant therapy during the study period.
  • Disease duration could not be assessed.