Idiopathic inflammatory demyelinating disease of the central nervous system in patients with inflammatory bowel disease: Retrospective analysis of 9095 patients

K. M. De Felice, M. Novotna, Felicity T Enders, William Alvis Faubion, W. J. Tremaine, Orhun H Kantarci, Laura E. H. Raffals

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Abstract

Background: Anti-TNFα biologics induce and maintain remission in inflammatory bowel disease (IBD). Also, they have been reported to induce or unmask idiopathic inflammatory demyelinating disease of the central nervous system (IIDD). Aim: To determine if anti-TNFα biologics increased the risk of IIDD in a large cohort of patients with IBD. Methods: We retrospectively identified adult patients referred to the Mayo Clinic, Rochester, MN for management of IBD from a five state capture area (Minnesota, Wisconsin, North Dakota, South Dakota and Iowa) between 1996 and 2010. IIDDs were identified in both Crohn's disease (CD) and ulcerative colitis (UC) patients with and without anti-TNFα exposure using the 2010 McDonald MRI criteria. The risk of IIDDs in patients with and without anti-TNFα exposure was estimated for IBD; CD and UC groups separately. Results: A total of 9095 patients with IBD were identified (4342 CD and 4753 UC). Four patients with CD with exposure to anti-TNFα agents (4/2054) and five patients with CD without anti-TNFα exposure (5/2288) developed a confirmed IIDD. One patient with UC with exposure to anti-TNFα agents (1/1371) and five patients with UC without anti-TNFα agents developed a confirmed IIDD (5/3382). The per cent of IIDDs in patients with and without anti-TNFα exposure was; IBD: 0.15% and 0.18% (RR = 0.83, 95% CI: 0.28-2.42; P = 0.729); CD: 0.19% and 0.22% (RR = 0.89, 95% CI: 0.24-3.31; P = 0.863); UC: 0.07% and 0.15% (RR = 0.49, 95% CI: 0.06-4.22; P = 0.510). Conclusion: Anti-TNFα biologics do not appear to impact the risk of developing clinical idiopathic inflammatory demyelinating disease in patients with inflammatory bowel disease.

Original languageEnglish (US)
Pages (from-to)99-107
Number of pages9
JournalAlimentary Pharmacology and Therapeutics
Volume41
Issue number1
DOIs
StatePublished - Jan 1 2015

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Demyelinating Diseases
Inflammatory Bowel Diseases
Central Nervous System
Ulcerative Colitis
Crohn Disease
Biological Products

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

@article{6be2a36a7f3b45b19980c67f290e046a,
title = "Idiopathic inflammatory demyelinating disease of the central nervous system in patients with inflammatory bowel disease: Retrospective analysis of 9095 patients",
abstract = "Background: Anti-TNFα biologics induce and maintain remission in inflammatory bowel disease (IBD). Also, they have been reported to induce or unmask idiopathic inflammatory demyelinating disease of the central nervous system (IIDD). Aim: To determine if anti-TNFα biologics increased the risk of IIDD in a large cohort of patients with IBD. Methods: We retrospectively identified adult patients referred to the Mayo Clinic, Rochester, MN for management of IBD from a five state capture area (Minnesota, Wisconsin, North Dakota, South Dakota and Iowa) between 1996 and 2010. IIDDs were identified in both Crohn's disease (CD) and ulcerative colitis (UC) patients with and without anti-TNFα exposure using the 2010 McDonald MRI criteria. The risk of IIDDs in patients with and without anti-TNFα exposure was estimated for IBD; CD and UC groups separately. Results: A total of 9095 patients with IBD were identified (4342 CD and 4753 UC). Four patients with CD with exposure to anti-TNFα agents (4/2054) and five patients with CD without anti-TNFα exposure (5/2288) developed a confirmed IIDD. One patient with UC with exposure to anti-TNFα agents (1/1371) and five patients with UC without anti-TNFα agents developed a confirmed IIDD (5/3382). The per cent of IIDDs in patients with and without anti-TNFα exposure was; IBD: 0.15{\%} and 0.18{\%} (RR = 0.83, 95{\%} CI: 0.28-2.42; P = 0.729); CD: 0.19{\%} and 0.22{\%} (RR = 0.89, 95{\%} CI: 0.24-3.31; P = 0.863); UC: 0.07{\%} and 0.15{\%} (RR = 0.49, 95{\%} CI: 0.06-4.22; P = 0.510). Conclusion: Anti-TNFα biologics do not appear to impact the risk of developing clinical idiopathic inflammatory demyelinating disease in patients with inflammatory bowel disease.",
author = "{De Felice}, {K. M.} and M. Novotna and Enders, {Felicity T} and Faubion, {William Alvis} and Tremaine, {W. J.} and Kantarci, {Orhun H} and Raffals, {Laura E. H.}",
year = "2015",
month = "1",
day = "1",
doi = "10.1111/apt.12997",
language = "English (US)",
volume = "41",
pages = "99--107",
journal = "Alimentary Pharmacology and Therapeutics",
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TY - JOUR

T1 - Idiopathic inflammatory demyelinating disease of the central nervous system in patients with inflammatory bowel disease

T2 - Retrospective analysis of 9095 patients

AU - De Felice, K. M.

AU - Novotna, M.

AU - Enders, Felicity T

AU - Faubion, William Alvis

AU - Tremaine, W. J.

AU - Kantarci, Orhun H

AU - Raffals, Laura E. H.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: Anti-TNFα biologics induce and maintain remission in inflammatory bowel disease (IBD). Also, they have been reported to induce or unmask idiopathic inflammatory demyelinating disease of the central nervous system (IIDD). Aim: To determine if anti-TNFα biologics increased the risk of IIDD in a large cohort of patients with IBD. Methods: We retrospectively identified adult patients referred to the Mayo Clinic, Rochester, MN for management of IBD from a five state capture area (Minnesota, Wisconsin, North Dakota, South Dakota and Iowa) between 1996 and 2010. IIDDs were identified in both Crohn's disease (CD) and ulcerative colitis (UC) patients with and without anti-TNFα exposure using the 2010 McDonald MRI criteria. The risk of IIDDs in patients with and without anti-TNFα exposure was estimated for IBD; CD and UC groups separately. Results: A total of 9095 patients with IBD were identified (4342 CD and 4753 UC). Four patients with CD with exposure to anti-TNFα agents (4/2054) and five patients with CD without anti-TNFα exposure (5/2288) developed a confirmed IIDD. One patient with UC with exposure to anti-TNFα agents (1/1371) and five patients with UC without anti-TNFα agents developed a confirmed IIDD (5/3382). The per cent of IIDDs in patients with and without anti-TNFα exposure was; IBD: 0.15% and 0.18% (RR = 0.83, 95% CI: 0.28-2.42; P = 0.729); CD: 0.19% and 0.22% (RR = 0.89, 95% CI: 0.24-3.31; P = 0.863); UC: 0.07% and 0.15% (RR = 0.49, 95% CI: 0.06-4.22; P = 0.510). Conclusion: Anti-TNFα biologics do not appear to impact the risk of developing clinical idiopathic inflammatory demyelinating disease in patients with inflammatory bowel disease.

AB - Background: Anti-TNFα biologics induce and maintain remission in inflammatory bowel disease (IBD). Also, they have been reported to induce or unmask idiopathic inflammatory demyelinating disease of the central nervous system (IIDD). Aim: To determine if anti-TNFα biologics increased the risk of IIDD in a large cohort of patients with IBD. Methods: We retrospectively identified adult patients referred to the Mayo Clinic, Rochester, MN for management of IBD from a five state capture area (Minnesota, Wisconsin, North Dakota, South Dakota and Iowa) between 1996 and 2010. IIDDs were identified in both Crohn's disease (CD) and ulcerative colitis (UC) patients with and without anti-TNFα exposure using the 2010 McDonald MRI criteria. The risk of IIDDs in patients with and without anti-TNFα exposure was estimated for IBD; CD and UC groups separately. Results: A total of 9095 patients with IBD were identified (4342 CD and 4753 UC). Four patients with CD with exposure to anti-TNFα agents (4/2054) and five patients with CD without anti-TNFα exposure (5/2288) developed a confirmed IIDD. One patient with UC with exposure to anti-TNFα agents (1/1371) and five patients with UC without anti-TNFα agents developed a confirmed IIDD (5/3382). The per cent of IIDDs in patients with and without anti-TNFα exposure was; IBD: 0.15% and 0.18% (RR = 0.83, 95% CI: 0.28-2.42; P = 0.729); CD: 0.19% and 0.22% (RR = 0.89, 95% CI: 0.24-3.31; P = 0.863); UC: 0.07% and 0.15% (RR = 0.49, 95% CI: 0.06-4.22; P = 0.510). Conclusion: Anti-TNFα biologics do not appear to impact the risk of developing clinical idiopathic inflammatory demyelinating disease in patients with inflammatory bowel disease.

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