Risk for inflammatory bowel disease (IBD) in patients with psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS) was not higher with the initiation of interleukin (IL)-17 inhibitors compared with etanercept, according to study results published in Arthritis & Rheumatology.
Researchers conducted a nationwide cohort study in France using the national health database to determine whether IL-17 inhibition was association with a higher risk for IBD in patients with psoriasis, PsA, and AS.
Patients with psoriasis and PsA or AS who were new users of IL-17 inhibitors were included in the current study. The control group included new users of apremilast and new users of etanercept.
Primary study endpoint was the occurrence of IBD.
Total users for IL-17 inhibitors, apremilast, and etanercept were 16,793, 20,556, and 10,245, respectively. Overall, the researchers observed 132 IBD cases: 72 (0.43%) in the IL-17 inhibitor group, 11 (0.05%) in the apremilast group, and 49 (0.48%) in etanercept group. The percentage of IBD cases occurring after 6 months in the IL-17 inhibitor, apremilast, and etanercept groups were 82%, 55% and 76%, respectively.
After propensity score matching, risk for IBD was significantly greater among patients who received treatment with IL-17 inhibitors compared with those who received apremilast (weighted hazard ratio [HRw], 3.8; 95% CI, 2.1-6.8), but not those who received etanercept (HRw, 0.8; 95% CI, 0.5-1.2).
The study was limited by using health care reimbursement data, and not days of use, as the definition for drug exposure; the risk for confounding bias; limited data on psoriasis and PsA or AS activity, individual risk factors, and family history of IBD, and the inability to account for over-the-counter nonsteroidal anti-inflammatory drug use.
According to the researchers, “These results need to be confirmed in other large databases.”
Penso L, Bergqvist C, Meyer A, et al. Risk of inflammatory bowel disease in patients with psoriasis, psoriatic arthritis and ankylosing spondylitis initiating interleukin 17 inhibitors: a nationwide population-based study using the French national health data system. Arthritis Rheumatol. Published online July 19, 2021. doi:10.1002/art.41923