288 Losartan-associated sprue-like enteropathy in a post-lung transplant cystic fibrosis patient

Sawant, A.P.; Spoletini, Giulia; Etherington, C.; Ford, Alexander C.; Whitaker, Paul; Clifton, Ian; Peckham, D.

doi:10.1016/s1569-1993(17)30627-6

Cited by 4 publications

(3 citation statements)

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“…A large observational cohort study, based on the French health insurance claim database and using International Classification of Diseases, Tenth Revision (ICD‐10) codes for intestinal malabsorption (IM) and coeliac disease diagnosis, highlighted an increased risk of hospitalization in patients treated with OM when compared with other ARBs and angiotensin converting enzyme inhibitors (ACE‐i) . Otherwise, it is not appropriate to rule out the class‐effect hypothesis because recent case reports suggested an association between severe enteropathy and other ARBs, including valsartan, irbesartan, telmisartan, eprosartan, losartan, and candesartan , . A large population‐based study of ARB‐treated patients managed by the general practitioners in Italy and Germany showed similar low proportions of unspecified IM diagnosis among the different drugs belonging to the same class.…”

Section: Introductionsupporting

confidence: 89%

“…11 Otherwise, it is not appropriate to rule out the class-effect hypothesis 12 because recent case reports suggested an association between severe enteropathy and other ARBs, including valsartan, irbesartan, telmisartan, eprosartan, losartan, and candesartan. 10,[13][14][15][16][17][18][19][20] A large population-based study of ARB-treated patients managed by the general practitioners in Italy and Germany showed similar low proportions of unspecified IM diagnosis among the different drugs belonging to the same class. This suggests the absence of differences among different ARBs and shows the very low incidence of IM in association with their intake.…”

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confidence: 99%

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Severe intestinal malabsorption associated with ACE inhibitor or angiotensin receptor blocker treatment. An observational cohort study in Germany and Italy

Malfertheiner

Ripellino²,

Cataldo³

2018

Pharmacoepidemiology and Drug

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PurposeThe angiotensin II receptor blocker (ARB) olmesartan has been recently associated with sprue‐like enteropathy (SLE), a gastrointestinal condition characterized by intestinal malabsorption (IM) and severe diarrhea. Whether the increased risk of SLE is substance‐specific or a class effect involving all ARBs is uncertain. The aim of this study is to assess the risk of enteropathy associated with ARBs and angiotensin converting enzyme inhibitors (ACE‐i) by using data from large administrative and claim databases.MethodsWe obtained data from Italian local health‐care units and a large German claim database and included patients treated with olmesartan, other ARBs, and ACE‐i. In the absence of a specific diagnosis code for SLE, International Classification of Diseases codes for IM were used. Analysis implemented a Poisson regression with robust error variance procedure, which allowed accounting for different clusters (local health‐care units and countries) and correctly estimating the standard error for the relative risk of rare event occurrence.ResultsPatients were divided into 3 groups: olmesartan (25.591, 5.5%), other ARBs (104.901, 22.5%), and ACE‐i patients (334.951, 72.0%). Baseline characteristics were similar overall. The incidence of unspecified IM in ACE‐i patients was not different compared with that of olmesartan, whereas a higher rate ratio was observed when comparing ARB patients with the olmesartan group (RR: 2.50, 95% CI 1.21 to 5.19, P .01). When International Classification of Diseases codes for coeliac disease were included, no differences were observed.ConclusionsWe could not confirm previous findings of a higher risk of malabsorption in olmesartan‐only patients, and drug‐induced enteropathy should be considered the result of exposure to the class of ARBs rather than a specific drug‐related effect.

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Section: Introductionsupporting

confidence: 89%

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confidence: 99%

Severe intestinal malabsorption associated with ACE inhibitor or angiotensin receptor blocker treatment. An observational cohort study in Germany and Italy

Malfertheiner

Ripellino²,

Cataldo³

2018

Pharmacoepidemiology and Drug

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“…SLE was reported in patients receiving candesartan (n = 1), 16 eprosartan (n = 1), 17 irbesartan (n = 4), 18‐20 losartan (n = 7), 15,21‐25 ; telmisartan (n = 4) 26‐29 and valsartan (n = 4) 20,30,31 …”

Section: Resultsmentioning

confidence: 99%

Severe cases of sprue‐like enteropathy associated with angiotensin receptor blockers other than olmesartan

Malfertheiner

Formigoni²

2021

GastroHep

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Summary Background Sprue‐like enteropathy (SLE) has been reported in patients with arterial hypertension who are treated with the angiotensin receptor blocker (ARB) olmesartan. It is currently controversial whether this is a class effect or specific to olmesartan. Methods A systematic literature search was conducted in Medline/PubMed, Embase, Web of Science and Scopus without language, publication year or publication status restrictions up to October 2019 to retrieve publications on SLE related to all ARBs excluding olmesartan. Results Overall, 17 reports including a total of 21 patients describing SLE cases were identified with the following ARBs: candesartan (n = 1), eprosartan (n = 1), irbesartan (n = 4), losartan (n = 7), telmisartan (n = 4) and valsartan (n = 4). The treatment duration among these ARB‐treated patients varied from 2 months to up to 13 years, while the onset of enteropathy‐related symptoms ranged from 2 months to 10 years from treatment initiation. The most frequently reported SLE symptoms were as follows: chronic diarrhoea, abdominal symptoms, loss of appetite and weight loss (3‐27 kg). Symptomatic treatment with antibiotics, corticosteroids and dietary modifications did not significantly improve the SLE symptoms in patients while on treatment with ARBs. However, diarrhoea resolved in all 21 patients after the withdrawal of ARBs and other gastrointestinal symptoms had resolved on follow‐up in all but two patients. Conclusions SLE is observed in patients treated with ARBs other than olmesartan. This suggests a class effect in the rare event of patients treated with ARBs developing SLE.

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Association of sprue-like enteropathy and angiotensin receptor-1 antagonists

Wenzel

Datz

2019

Wien Klin Wochenschr

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288 Losartan-associated sprue-like enteropathy in a post-lung transplant cystic fibrosis patient

Cited by 4 publications

References 0 publications

Severe intestinal malabsorption associated with ACE inhibitor or angiotensin receptor blocker treatment. An observational cohort study in Germany and Italy

Severe intestinal malabsorption associated with ACE inhibitor or angiotensin receptor blocker treatment. An observational cohort study in Germany and Italy

Severe cases of sprue‐like enteropathy associated with angiotensin receptor blockers other than olmesartan

Association of sprue-like enteropathy and angiotensin receptor-1 antagonists

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