Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France.
Gut. 2020 May;69(5):852-858. doi: 10.1136/gutjnl-2019-318932. Epub 2019 Aug 24.
Patients with IBD are at increased risk of acute arterial events. Antitumour necrosis factor (TNF) agents and thiopurines may, via their anti-inflammatory properties, lower the risk of acute arterial events. The aim of this study was to assess the impact of thiopurines and anti-TNFs on the risk of acute arterial events in patients with IBD.
Patients aged 18 years or older and affiliated to the French national health insurance with a diagnosis of IBD were followed up from 1 April 2010 until 31 December 2014. The risks of acute arterial events (including ischaemic heart disease, cerebrovascular disease and peripheral artery disease) were compared between thiopurines and anti-TNFs exposed and unexposed patients with marginal structural Cox proportional hazard models adjusting for baseline and time-varying demographics, medications, traditional cardiovascular risk factors, comorbidities and IBD disease activity.
Among 177 827 patients with IBD (96 111 (54%) women, mean age at cohort entry 46.2 years (SD 16.3), 90 205 (50.7%) with Crohn's disease (CD)), 4145 incident acute arterial events occurred (incidence rates: 5.4 per 1000 person-years). Compared with unexposed patients, exposure to anti-TNFs (HR 0.79, 95% CI 0.66 to 0.95), but not to thiopurines (HR 0.93, 95% CI 0.82 to 1.05), was associated with a decreased risk of acute arterial events. The magnitude in risk reduction was highest in men with CD exposed to anti-TNFs (HR 0.54, 95% CI 0.40 to 0.72).
Exposure to anti-TNFs is associated with a decreased risk of acute arterial events in patients with IBD, particularly in men with CD.
炎症性肠病 (IBD) 患者发生急性动脉事件的风险增加。肿瘤坏死因子 (TNF) 拮抗剂和硫嘌呤类药物可能通过其抗炎特性降低急性动脉事件的风险。本研究旨在评估硫嘌呤类药物和抗 TNF 对 IBD 患者急性动脉事件风险的影响。
2010 年 4 月 1 日至 2014 年 12 月 31 日期间，年龄在 18 岁及以上并加入法国国家健康保险的 IBD 患者接受随访。使用边缘结构 Cox 比例风险模型比较了暴露于硫嘌呤类药物和抗 TNF 与未暴露于硫嘌呤类药物和抗 TNF 的患者的急性动脉事件（包括缺血性心脏病、脑血管病和外周动脉疾病）风险，该模型调整了基线和时变人口统计学、药物、传统心血管危险因素、合并症和 IBD 疾病活动度。
在 177827 例 IBD 患者（96111 例（54%）女性，入组时的平均年龄为 46.2 岁（16.3 岁），90205 例（50.7%）为克罗恩病 (CD)）中，发生了 4145 例急性动脉事件（发生率：每 1000 人年 5.4 例）。与未暴露的患者相比，暴露于抗 TNF（HR 0.79，95%CI 0.66 至 0.95），而不是硫嘌呤类药物（HR 0.93，95%CI 0.82 至 1.05），与急性动脉事件风险降低相关。在接受抗 TNF 治疗的 CD 男性患者中，风险降低幅度最大（HR 0.54，95%CI 0.40 至 0.72）。
暴露于抗 TNF 与 IBD 患者的急性动脉事件风险降低相关，特别是在接受抗 TNF 治疗的 CD 男性患者中。
