Risk of Developing Additional Immune-Mediated Manifestations: A Retrospective Matched Cohort Study

Aletaha, Daniel; Epstein, Andrew J.; Skup, Martha; Zueger, Patrick; Garg, Vishvas; Panaccione, Remo

doi:10.1007/s12325-019-00964-z

Cited by 44 publications

(61 citation statements)

References 18 publications

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“…On the one hand, the limited number of patients, and on the other, its retrospective nature with the lack of follow-up of some patients. Furthermore, some studies have shown an association between HS and Crohn's disease [24], as well as with other IMIDs such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis [25]. It has been hypothesized that IMIDs share common genetic origins that may increase patients' susceptibility to the development of multiple, apparently unrelated IMIDs.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical Hidradenitis Suppurativa in Patients Receiving TNF-α Inhibitors: Case Series, Systematic Review, and Case Meta-Analysis

et al. 2020

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Background/Aims: TNF-α inhibitors represent the most advanced approved therapeutic option for moderate and severe forms of hidradenitis suppurativa (HS). However, in recent years, cases of paradoxical HS secondary to the use of these biological drugs have been described, with very few cases reported in the literature. The aims of this study are (1) to present 2 new cases of paradoxical HS and (2) to perform a systematic review of scientific evidence regarding paradoxical HS with TNF-α inhibitors. Material and Methods: This is a retrospective study in which we searched all the cases of paradoxical HS secondary to the use of TNF-α inhibitors published in the literature and included two additional cases observed in our clinical practice. Results: A total of 34 patients under TNF-α inhibitor treatment were included (adalimumab = 21; infliximab = 9; etanercept = 4). The median delay from exposure to TNF-α inhibitor and the development of paradoxical HS was 12 months (range 1–72). The majority of patients were Hurley stage II (58.8%). Clinical improvement and complete remission were more frequent when the TNF-α inhibitor was stopped or switched to another biological agent with a different therapeutic target rather than maintenance or change to another TNF-α inhibitor. Conclusions: Paradoxical HS is an unusual adverse effect of TNF-α inhibitors. When this adverse effect appears, interruption or substitution of treatment is associated with a better clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Paradoxical Hidradenitis Suppurativa in Patients Receiving TNF-α Inhibitors: Case Series, Systematic Review, and Case Meta-Analysis

et al. 2020

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“…The characteristics of these studies are outlined in Tables 1 and 2. The studies were published between 2007 and 2019 and conducted in the USA [10,11,13,17,18], Korea [9,14,15], Denmark [12,16], and Finland [19]. Three publications [15][16][17] were retrospective cohort studies, two [18,19] were case-control studies and the other six [9][10][11][12][13][14] were cross-sectional studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The studies were published between 2007 and 2019 and conducted in the USA [10,11,13,17,18], Korea [9,14,15], Denmark [12,16], and Finland [19]. Three publications [15][16][17] were retrospective cohort studies, two [18,19] were case-control studies and the other six [9][10][11][12][13][14] were cross-sectional studies. Six studies [9,12,[14][15][16] were based on nationwide populationbased databases, four [10,11,13,17] were based on large administrative databases and the other one [18] was based on single-center biobank.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In recent years, an increasing number of studies have noted that RA tended to cluster with IBD [9][10][11][12][13][14] and that patients with IBD are more likely to develop RA [15][16][17][18]. In contrast, a nationwide population-based case-control study indicated there was a decreased risk of RA in patients with IBD, although the decrease was not statistically significant [19].…”

Section: Introductionmentioning

confidence: 99%

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The risk of rheumatoid arthritis among patients with inflammatory bowel disease: a systematic review and meta-analysis

Chen

Xing

et al. 2020

BMC Gastroenterol

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Background: Studies have suggested that patients with inflammatory bowel disease (IBD) have an increased risk of rheumatoid arthritis (RA). However, the available data on this association are inconsistent. This meta-analysis aimed to determine the association between IBD and the risk of RA. Methods: Observational studies investigating the RA risk among patients with IBD (Crohn disease (CD) and/or ulcerative colitis (UC)) were searched in PubMed, Embase, and Web of Science from the date of inception to December 2019. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Relative risks (RRs) and corresponding 95% confidential intervals (CIs) were pooled with a random-effects model. Heterogeneity was evaluated using I 2 statistics while publication bias was determined using Begg's and Egger's tests. Subgroup and sensitivity analyses were performed. Results: A total of three cohort studies, three cross-sectional studies, and two case-control studies were included in the meta-analyses. Compared to the non-IBD control or general population, there was a significantly higher risk of RA among patients with IBD (RR = 2.59; 95% CI: 1.93-3.48). Moreover, both CD (RR = 3.14; 95% CI: 2.46-4.01) and UC (RR = 2.29; 95% CI: 1.76-2.97) were associated with a significantly increased risk of RA. However, heterogeneity was substantial across studies and the subgroup analyses failed to identify the potential source of heterogeneity. Conclusions: Patients with IBD have a greater risk of developing RA. Rheumatologists should be consulted when patients with IBD present with undifferentiated joint complaints. However, more prospective cohort studies are needed to validate these results.

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“…The literature search identified 3 risk factors associated with IBD: concomitant hidradenitis suppurativa (HS) [37][38][39][40][41] (supplementary Fig. S5 and Table S4), presence of the first-degree relative with IBD 42-57 (supplementary Fig.…”

Section: Impact Of Risk Factors On Ibd In Patients Exposed To Il-17imentioning

confidence: 99%

Risk of Inflammatory Bowel Disease in Psoriasis Patients Treated with Anti-Interleukin-17 Agents: A Bayesian Metaanalysis

Gill

Pietrosanu

Gniadecki

2019

Preprint

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Background: Use of interleukin-17 inhibitors (IL-17i) in psoriasis has been associated with an increased risk of inflammatory bowel disease (IBD). However, the clinical significance of this association is not understood. Objectives: To quantify the absolute risk of IBD in patients with psoriasis treated with IL-17i, stratified by known IBD risk factors. Methods: Literature searches were performed to identify known IBD risk factors and the prevalences were quantified by a meta-analysis of proportions. The Bayesian model was used to estimate the probability of a new-onset or a flare of IBD in patients with psoriasis. Results: The prevalence of Crohn disease (CD) or ulcerative colitis (UC) in the general psoriasis population was 0.0010. Use of IL-17i increased the risk of CD to 0.0037 and UC to 0.0028, translating to a number needed to harm (NNH) of 373 for CD and 564 for UC. In patients who had concomitant hidradenitis suppurativa, the use of IL-17i was associated with a decrease in NNH for CD and UC to 18 and 76, respectively, whereas for patients with a family history of IBD, the NNH values were 6 (for CD) and 10 (for UC). Conclusions: In patients with no risk factors, the probability of IBD flare or onset during IL-17i treatment is negligible and additional IBD screening procedures are not indicated. In contrast, the patients with psoriasis who have hidradenitis suppurativa or first-degree family history of IBD as risk factors should be monitored for signs and symptoms of CD and UC during IL-17i therapy.

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Risk of Developing Additional Immune-Mediated Manifestations: A Retrospective Matched Cohort Study

Cited by 44 publications

References 18 publications

Paradoxical Hidradenitis Suppurativa in Patients Receiving TNF-α Inhibitors: Case Series, Systematic Review, and Case Meta-Analysis

Paradoxical Hidradenitis Suppurativa in Patients Receiving TNF-α Inhibitors: Case Series, Systematic Review, and Case Meta-Analysis

The risk of rheumatoid arthritis among patients with inflammatory bowel disease: a systematic review and meta-analysis

Risk of Inflammatory Bowel Disease in Psoriasis Patients Treated with Anti-Interleukin-17 Agents: A Bayesian Metaanalysis

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