In the JournalsPerspective

Nearly one-quarter of patients with IBD have a concurrent IMID

A Danish cohort study revealed that nearly one-in-four patients with inflammatory bowel disease have another immune mediated inflammatory disease which can impact disease course and increase severity.

Johan Burisch, MD, PhD, of the Center for Clinical Research and Prevention at Bispebjerg and Frederiksberg Hospital in Denmark, and colleagues wrote that previous studies have explored the overall prevalence of IMIDs, as well as the increased risk for IMIDs among patients with IBD. However, less attention has been paid to the timing of the onset of IMIDs and their impact on disease course.

“The co-occurrence of other IMIDs in IBD patients is a challenge for the treating physicians, requiring multidisciplinary management,” they wrote. “Moreover, IBD patients with concurrent IMIDs tend to experience increased disease severity. Therefore, understanding co-occurrence patterns and overall disease burden would be of great value.”

Researchers analyzed data from a nationwide cohort of all patients diagnosed with IBD between 2007 and 2016 (n = 14,377). They matched patients with individuals without IBD from the general population (n = 71,885).

Of the patients with IBD, 3,235 were also diagnosed with an IMID (22.5%), the most common of which were psoriasis, asthma, type 1 diabetes and iridocyclitis. Most of these patients were diagnosed with the IMID prior to the onset of IBD (n = 2,600; 80.3%).

A concurrent IMID increased the risk for surgery in patients with Crohn’s disease if they developed the IMID after onset of IBD (adjusted OR = 2.3; 95% CI, 1.46–4.2). There was no increased risk for surgery among patients with ulcerative colitis.

Patients with IBD who had undergone therapy with Remicade (infliximab, Janssen) had a reduced risk for developing an IMID (CD: aOR = 0.52; 95% CI, 0.34–0.81 and UC: aOR = 0.47; 95% CI, 0.29–0.76).

“Co-occurrence of IMIDs with IBD was associated with a higher risk of surgery in CD patients, and a higher risk of needing biological therapy in CD and UC patients,” Burisch and colleagues concluded. “This apparent worsening of the disease course in IBD patients with other IMIDs merits further research into its clinical consequences and the underlying enteropathogenic mechanisms.” – by Alex Young

Disclosures: Burisch reports consulting fees from AbbVie, Celgene, Ferring and Janssen-Cilag; lecture fees from AbbVie, MSD, Pfizer and Takeda Pharma. He also reports receiving unrestricted grants from AbbVie and Takeda Pharma. Please see the full study for all other authors’ relevant financial disclosures.

A Danish cohort study revealed that nearly one-in-four patients with inflammatory bowel disease have another immune mediated inflammatory disease which can impact disease course and increase severity.

Johan Burisch, MD, PhD, of the Center for Clinical Research and Prevention at Bispebjerg and Frederiksberg Hospital in Denmark, and colleagues wrote that previous studies have explored the overall prevalence of IMIDs, as well as the increased risk for IMIDs among patients with IBD. However, less attention has been paid to the timing of the onset of IMIDs and their impact on disease course.

“The co-occurrence of other IMIDs in IBD patients is a challenge for the treating physicians, requiring multidisciplinary management,” they wrote. “Moreover, IBD patients with concurrent IMIDs tend to experience increased disease severity. Therefore, understanding co-occurrence patterns and overall disease burden would be of great value.”

Researchers analyzed data from a nationwide cohort of all patients diagnosed with IBD between 2007 and 2016 (n = 14,377). They matched patients with individuals without IBD from the general population (n = 71,885).

Of the patients with IBD, 3,235 were also diagnosed with an IMID (22.5%), the most common of which were psoriasis, asthma, type 1 diabetes and iridocyclitis. Most of these patients were diagnosed with the IMID prior to the onset of IBD (n = 2,600; 80.3%).

A concurrent IMID increased the risk for surgery in patients with Crohn’s disease if they developed the IMID after onset of IBD (adjusted OR = 2.3; 95% CI, 1.46–4.2). There was no increased risk for surgery among patients with ulcerative colitis.

Patients with IBD who had undergone therapy with Remicade (infliximab, Janssen) had a reduced risk for developing an IMID (CD: aOR = 0.52; 95% CI, 0.34–0.81 and UC: aOR = 0.47; 95% CI, 0.29–0.76).

“Co-occurrence of IMIDs with IBD was associated with a higher risk of surgery in CD patients, and a higher risk of needing biological therapy in CD and UC patients,” Burisch and colleagues concluded. “This apparent worsening of the disease course in IBD patients with other IMIDs merits further research into its clinical consequences and the underlying enteropathogenic mechanisms.” – by Alex Young

Disclosures: Burisch reports consulting fees from AbbVie, Celgene, Ferring and Janssen-Cilag; lecture fees from AbbVie, MSD, Pfizer and Takeda Pharma. He also reports receiving unrestricted grants from AbbVie and Takeda Pharma. Please see the full study for all other authors’ relevant financial disclosures.

    Perspective
    Laura Raffals

    Laura Raffals

    The most striking finding from this study is how common immune mediated inflammatory diseases (IMID) are in patients with inflammatory bowel disease (IBD). In this cohort, almost one in every four patients with IBD had a diagnosis of an IMID and the majority of those patients were diagnosed with their IMID before their diagnosis of IBD.

    The findings from this study are important for primary care providers and gastroenterologists alike. The study highlights the need to consider and, if appropriate, exclude IBD in patients with IMID who present with GI symptoms. Of interest, IBD patients who developed an IMID after their IBD diagnosis were more likely to require biologic therapy and those patients with Crohn’s disease were more likely to require surgery. These finding raise the question of whether there is something different about these patients, that they have a more aggressive disease course. For this group of patients, this study provides additional evidence to support a proactive approach to treat and monitor the underlying IBD.

    This study prompts us to ask important questions about the etiopathogeneis of IBD. For instance, why do some patients experience more than one IMID and is there a unifying pathogenic mechanism at play? If we can uncover the common pathogenic links between IMIDs we may improve our targets for therapy, improving the care we can provide our patients living with IBD.

    • Laura Raffals, MD, MS
    • Associate Professor of Medicine
      Division of Gastroenterology and Hepatology
      Mayo Clinic

    Disclosures: Raffals reports no relevant financial disclosures.