Chronic comorbidities associated with inflammatory bowel disease: prevalence and impact on healthcare costs in Switzerland

Bähler, Caroline; Schoepfer, Alain; Vavricka, Stephan R.; Brüngger, Beat; Reich, Oliver

doi:10.1097/meg.0000000000000891

Cited by 75 publications

(38 citation statements)

References 49 publications

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“… 33 Type 2 diabetes and inflammatory bowel disease have been shown to share inflammatory pathways, 34 although large population based studies have not reported an association between these two diseases. 35 Nevertheless, we rigorously assessed the effect of possible residual confounding in several analyses; these analyses yielded consistent findings. Moreover, the null association observed with insulin (a last line treatment of which the users are typically at an advanced disease stage) as a negative control provides reassurance on the internal validity of our findings.…”

Section: Discussionmentioning

confidence: 90%

Dipeptidyl peptidase-4 inhibitors and incidence of inflammatory bowel disease among patients with type 2 diabetes: population based cohort study

Abrahami

Douros

Yin

et al. 2018

BMJ

105

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ObjectiveTo assess whether the use of dipeptidyl peptidase-4 inhibitors is associated with the incidence of inflammatory bowel disease in patients with type 2 diabetes.DesignPopulation based cohort study.SettingMore than 700 general practices contributing data to the United Kingdom Clinical Practice Research Datalink.ParticipantsA cohort of 141 170 patients, at least 18 years of age, starting antidiabetic drugs between 1 January 2007 and 31 December 2016, with follow-up until 30 June 2017.Main outcome measuresAdjusted hazard ratios for incident inflammatory bowel disease associated with use of dipeptidyl peptidase-4 inhibitors overall, by cumulative duration of use, and by time since initiation, estimated using time dependent Cox proportional hazards models. Use of dipeptidyl peptidase-4 inhibitors was modelled as a time varying variable and compared with use of other antidiabetic drugs, with exposures lagged by six months to account for latency and diagnostic delays.ResultsDuring 552 413 person years of follow-up, 208 incident inflammatory bowel disease events occurred (crude incidence rate of 37.7 (95% confidence interval 32.7 to 43.1) per 100 000 person years). Overall, use of dipeptidyl peptidase-4 inhibitors was associated with an increased risk of inflammatory bowel disease (53.4 v 34.5 per 100 000 person years; hazard ratio 1.75, 95% confidence interval 1.22 to 2.49). Hazard ratios gradually increased with longer durations of use, reaching a peak after three to four years of use (hazard ratio 2.90, 1.31 to 6.41) and decreasing after more than four years of use (1.45, 0.44 to 4.76). A similar pattern was observed with time since starting dipeptidyl peptidase-4 inhibitors. These findings remained consistent in several sensitivity analyses.ConclusionsIn this first population based study, the use of dipeptidyl peptidase-4 inhibitors was associated with an increased risk of inflammatory bowel disease. Although these findings need to be replicated, physicians should be aware of this possible association.

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Section: Discussionmentioning

confidence: 90%

Dipeptidyl peptidase-4 inhibitors and incidence of inflammatory bowel disease among patients with type 2 diabetes: population based cohort study

Abrahami

Douros

Yin

et al. 2018

BMJ

105

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“…The prevalence of comorbidities in our study was relatively low compared with other studies. [14][15][16] A plausible explanation might be that the median age of study patients was relatively young (approximately 44 years old). Another reason could be that many IBD specialists or even patients are reluctant to use biologic Open access therapy, and we cannot discard a possible overlap between comorbidities and EIMs due to the retrospective study design.…”

Section: Discussionmentioning

confidence: 99%

“…13 The prevalence of comorbidities in patients with IBD ranges between 30% and 70%. [14][15][16] The presence of comorbidities in patients with IBD has been shown to negatively affect patients' HRQoL, 16 and importantly to prolong their length of hospital stay and increase the risk of postsurgical mortality. Furthermore, immune-mediated inflammatory disorders associated with IBD have been proven to incur higher healthcare costs.…”

Section: What Are the New Findings?mentioning

confidence: 99%

“…Furthermore, immune-mediated inflammatory disorders associated with IBD have been proven to incur higher healthcare costs. 14 In addition, up to 50% of patients with IBD may develop extraintestinal manifestations (EIMs) of the disease, 17 involving multiple organ systems throughout the body, 17 18 and sometimes being even more debilitating than the intestinal disease itself. 19 In recent decades, the objective of IBD treatment has evolved from a symptomatic relief to symptomatic and endoscopic deep remission.…”

Section: What Are the New Findings?mentioning

confidence: 99%

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Impact of comorbidities on anti-TNFα response and relapse in patients with inflammatory bowel disease: the VERNE study

Marín-Jiménez

Bastida

Forés

et al. 2020

BMJ Open Gastroenterol

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ObjectiveTo evaluate the impact of comorbidities and extraintestinal manifestations of inflammatory bowel disease on the response of patients with inflammatory bowel disease to antitumour necrosis factor alpha (anti-TNFα) therapy.DesignData from 310 patients (194 with Crohn’s disease and 116 with ulcerative colitis) treated consecutively with the first anti-TNFα in 24 Spanish hospitals were retrospectively analysed. Univariate and multivariate logistic regression analyses were performed to assess the associations between inflammatory bowel disease comorbidities and extraintestinal manifestations with anti-TNFα treatment outcomes. Key clinical features, such as type of inflammatory bowel disease and concomitant treatments, were included as fixed factors in the model.ResultsMultivariate logistic regression analyses (OR, 95% CI) showed that chronic obstructive pulmonary disease (2.67, 1.33 to 5.35) and hepato-pancreato-biliary diseases (1.87, 1.48 to 2.36) were significantly associated with primary non-response to anti-TNFα, as was the use of corticosteroids and the type of inflammatory bowel disease (ulcerative colitis vs Crohn’s disease). It was also found that myocardial infarction (3.30, 1.48 to 7.35) and skin disease (2.73, 1.42 to 5.25) were significantly associated with loss of response, along with the use of corticosteroids and the type of inflammatory bowel disease (ulcerative colitis vs Crohn’s disease).ConclusionsOur results suggest that the presence of some comorbidities in patients with inflammatory bowel disease, such as chronic obstructive pulmonary disease and myocardial infarction, and of certain extraintestinal manifestations of inflammatory bowel disease, such as hepato-pancreato-biliary conditions and skin diseases, appear to be related to failure to anti-TNFα treatment. Therefore, their presence should be considered when choosing a treatment.Trial registration numberNCT02861118.

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“…Both are chronic diseases that are associated with increased risk of cardiovascular disease and premature mortality ( 33 , 34 ). Despite the potential overlaps, earlier studies have not been able to demonstrate a higher risk of diabetes in patients with inflammatory bowel disease ( 35 – 38 ). However, in a recent study from the UK, the prevalence of clinical inflammatory bowel disease in adult individuals with type 1 diabetes was ~6-fold higher compared to non-diabetic controls (1.5 vs. 0.3%, respectively) ( 39 ).…”

Section: Gastrointestinal Manifestations In Patients With Diabetesmentioning

confidence: 95%

The Gut-Kidney Axis: Putative Interconnections Between Gastrointestinal and Renal Disorders

Lehto

Groop

2018

Front. Endocrinol.

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Diabetic kidney disease (DKD) is a devastating condition associated with increased morbidity and premature mortality. The etiology of DKD is still largely unknown. However, the risk of DKD development and progression is most likely modulated by a combination of genetic and environmental factors. Patients with autoimmune diseases, like type 1 diabetes, inflammatory bowel disease, and celiac disease, share some genetic background. Furthermore, gastrointestinal disorders are associated with an increased risk of kidney disease, although the true mechanisms have still to be elucidated. Therefore, the principal aim of this review is to evaluate the impact of disturbances in the gastrointestinal tract on the development of renal disorders.

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Chronic comorbidities associated with inflammatory bowel disease: prevalence and impact on healthcare costs in Switzerland

Abstract: We found a considerably high prevalence of concomitant chronic diseases in IBD patients. This was associated with considerably higher healthcare costs, especially in the outpatient setting.

Cited by 75 publications

References 49 publications

Dipeptidyl peptidase-4 inhibitors and incidence of inflammatory bowel disease among patients with type 2 diabetes: population based cohort study

Dipeptidyl peptidase-4 inhibitors and incidence of inflammatory bowel disease among patients with type 2 diabetes: population based cohort study

Impact of comorbidities on anti-TNFα response and relapse in patients with inflammatory bowel disease: the VERNE study

The Gut-Kidney Axis: Putative Interconnections Between Gastrointestinal and Renal Disorders

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