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Paradoxical Risks of Anti-TNF Therapy
In 2 national cohorts of patients with inflammatory bowel disease (IBD), antitumor necrosis factor (anti-TNF) therapy was associated with an increased risk of developing rheumatoid arthritis, psoriasis, and hidradenitis suppurativa, investigators reported in Clinical Gastroenterology and Hepatology.
Anti-TNFs have been mainstays of IBD treatment since the introduction of infliximab more than 20 years ago, and have also proved effective in treating other immune-mediated inflammatory diseases (IMIDs) such as rheumatoid arthritis and psoriasis.
“However, case reports have identified the paradoxical occurrence of IMIDs in patients treated with anti-TNF,” the authors stated. “We studied the risk of rheumatoid arthritis, psoriasis, and hidradenitis suppurativa after the initiation of anti-TNF therapy for inflammatory bowel disease” among patients in Denmark (2005–2018) and France (2008–2018). The combined cohort of 18,258 patients (Danish) and 88,786 subjects (French) with IBD yielded a total of 516,055 person-years of follow-up.
“We obtained individual-level information on exposure to anti-TNF, diagnoses of IMIDs including rheumatoid arthritis, psoriasis, and hidradenitis suppurativa, and potential confounders from healthcare registers in the respective countries,” the researchers explained, and used Cox models to estimate hazard ratios (HRs) for anti-TNF exposure and the development of additional IMIDs. “To test the robustness of our results, we performed an active comparator analysis of anti-TNF monotherapy vs azathioprine monotherapy,” the study team added.
“Anti-TNF was associated with an increased risk of rheumatoid arthritis, psoriasis, and hidradenitis suppurativa in both the Danish (HR, 1.66; 95% confidence interval [CI], 1.34–2.07) and the French cohort (HR, 1.78; 95% CI, 1.63–1.94), with a pooled HR of 1.76 (95% CI, 1.63–1.91),” the study team concluded. “Anti-TNF was also associated with an increased risk of the outcomes when compared with azathioprine (pooled HR, 2.94; 95% CI, 2.33–3.70).”
Reference:
Ward D, Andersen NN, Gørtz S, et al. Tumor necrosis factor inhibitors in inflammatory bowel disease and risk of immune mediated inflammatory diseases. Clin Gastroenterol Hepatol. Published online July 10, 2023. DOI: https://doi.org/10.1016/j.cgh.2023.06.025
