Patients receiving Enbrel for inflammatory diseases other than inflammatory bowel disease have an increased risk for a diagnosis of Crohn’s disease or ulcerative colitis, according to study results.
Joshua Korzenik, MD, director of the Crohn’s and Colitis Center at Brigham and Women’s Hospital, and colleagues wrote in Alimentary Pharmacology & Therapeutics that anti-TNF treatments have made a significant impact on the management of autoimmune disease like rheumatoid arthritis and IBD. However, they do not come without risks.
“Paradoxically, these agents might provoke the development of de novo autoimmune disease for which they are also utilized as therapy, such as de novo psoriasis and vasculitis,” they wrote.
To further explore a potential risk for IBD when taking an anti-TNF for other inflammatory diseases, researchers performed a nationwide cohort study using Danish health registries. They included patients with diseases other than IBD, including rheumatoid arthritis, psoriasis, psoriatic arthritis, spondylitis and others, who received at least one dose of anti-TNF.
Of 17,018 patients with an autoimmune disorder who received an anti-TNF, most received Remicade (infliximab, Janssen), Enbrel (etanercept, Amgen) or Humira (adalimumab, AbbVie). Researchers compared risk for IBD among these patients with 63,308 individuals who were not exposed to anti-TNF.
Investigators found that patients who received etanercept had an increased risk for CD (adjusted HR = 2; 95% CI, 1.4–2.8) and UC (aHR = 2; 95% CI, 1.5–2.8). They did not find an increased risk for de novo IBD among patients who received adalimumab or infliximab.
Korzenik and colleagues wrote they were uncertain about the reason for this link.
“This additional burden of disease is important to understand with regard to the insights the phenomenon may provide into the pathogenesis of IBD, as well as these other diseases,” they wrote. “In addition, the recognition of these clinical problems is critical for physicians caring for individuals being treated with anti-TNF alpha agents to minimize risk and provide optimal care.” – by Alex Young
Disclosures: Korzenik reports receiving research support from AbbVie and Pfizer and consulting for AbbVie, Janssen, Pfizer and Merck. Please see the full study for all other authors’ relevant financial disclosures.