Anti-TNF exposure in men with CD may protect against acute arterial events
Exposure to antitumour necrosis factor (anti-TNF) for inflammatory bowel disease (IBD) also confers benefits for the risk of acute arterial events, especially in men with Crohn’s disease (CD), as shown in a recent study.
The study included 177,827 adult patients with IBD (mean age at cohort entry, 46.2 years; 54 percent female; 50.7 percent with CD). Researchers compared the risk of acute arterial events (including ischaemic heart disease [IHD], cerebrovascular disease and peripheral artery disease [PAD]) between patients who had ever been exposed to thiopurines (n=43,881), to anti-TNFs (n=26,447) and to neither (n=120,983).
There were 4,145 incident acute arterial events recorded (52.0 percent IHD; 32.0 percent cerebrovascular diseases; 16.0 percent PAD), corresponding to an incidence rate of 5.4 per 1,000 person-years. Patients who experienced an acute arterial event during follow-up were predominantly men (64.1 percent) and diagnosed with UC (55.1 percent), with a mean age of 62.3 years at the index event.
Cox proportional hazard analysis revealed that compared with nonexposure, exposure to anti-TNFs exerted a protective effect on the risk of acute arterial events (hazard ratio [HR], 0.79, 95 percent CI, 0.66–0.95). Of note, the magnitude of risk reduction was highest in male CD patients exposed to anti-TNFs (HR, 0.54, 0.40–0.72).
Such effect was not observed with thiopurine exposure (HR, 0.93, 0.82–1.05).
In light of the present data, the researchers recommend that prevention of acute arterial events in patients with IBD be considered in the benefit–risk balance assessment of thiopurines and anti-TNFs.