Patients with chronic inflammatory diseases such as rheumatoid arthritis and psoriasis, but not inflammatory bowel disease (IBD), who are treated with anti-tumor necrosis factor α (TNFα) agents are at an increased risk of developing de novo Crohn disease or ulcerative colitis, according to results from a study published in Alimentary Pharmacology and Therapeutics.

The primary outcome measure of a cohort study to determine whether anti-TNFα agents for non-IBD autoimmune disease increase the risk for IBD was the number of patients with first-time discharge diagnoses of ulcerative colitis or Crohn disease from hospitals or hospital-based outpatient clinics in Denmark.

Participants were either exposed to anti-TNFα (n=17,018; 40.1% men) or not exposed to anti-TNFα (n=63,308; 38.1% men); 56.6% of the entire cohort was primarily diagnosed with rheumatoid arthritis, and the rest of the patients were primarily diagnosed with psoriasis/psoriatic arthritis or ankylosing spondylitis. Most exposure group patients were treated with infliximab, etanercept, and adalimumab; 34.1% were exposed to 2 types of anti-TNFα, and 16.7% were exposed to 3 or more types during the observation period.

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Patients treated with etanercept had a significantly increased risk of being diagnosed with Crohn disease or ulcerative colitis (adjusted hazard ratios were 2.0 for both diseases). For Crohn disease and ulcerative colitis, hazard ratios were 1.3 and 1.0, respectively, for infliximab, and 1.2 and 0.6 for adalimumab.

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“Specifically, we found that etanercept was associated with the development of de novo [ulcerative colitis and Crohn disease],” the authors noted. “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 other autoimmune diseases. In addition, the recognition of these clinical problems is critical for physicians caring for individuals being treated with anti-TNFα agents to minimise risk and provide optimal care.”

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Korzenik J, Larsen MD, Nielsen J, Kjeldsen J, Nørgård BM. Increase 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