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

Candesartan-Induced Enteropathy That Mimics Celiac Disease in a 90-Year-Old Patient

“…This supports a previous connection between the use of candesartan and enteropathy made by Monde et al [11]. Furthermore, our case supports the hypothesis that ARB-induced enteropathy is a class effect rather than a special adverse event for the ARB olmesartan [10] and expands the list of ARBs that have been associated with it. The CARE Checklist has been completed by the authors for this case report, attached as online supplementary material (for all online suppl.…”

“…The diagnosis of drug-induced SLE is based on histological evidence demonstrating villous atrophy and intraepithelial lymphocytosis that cannot be explained by other etiologies and regresses after discontinuation of the ARB in question [1, 10]. Based on these criteria, numerous studies have demonstrated an association between the use of ARBs and enteropathy.…”

“…This association has subsequently been supported by a case series of 36 patients with olmesartan-associated enteropathy in a French national survey [7]. Other ARBs have also been named as triggers of drug-induced SLE [8–10]. Monde et al [11] reported on a case of SLE associated with the ARB candesartan.…”

How to deal with the occurrence of rare drug-induced adverse events: the example of sprue-like enteropathy induced by olmesartan medoxomil and other angiotensin-receptor blockers

“…Villous atrophy and lymphocytic infiltration of the mucous membrane of the small intestine were detected, suggesting a localized delayed hypersensitivity or a cell-mediated immune response. Several subsequent reports have indicated that this drug-induced enteropathy can occur with other ARBs [2,3], indicating that this complication may be a class-effect of ARBs. Several recent large observation cohort studies that have been conducted in Europe did not confirm the increased risk of intestinal malabsorption with ARBs, including olmesartan, when compared with ACEi [4].…”

“…According to the review of studies by the Food and Drug Administration (FDA), gastrointestinal events in olmesartan medoxomil users affect only 3-147 per 100,000 patient-years [4,6,7]. Approximately, nine cases/100,000 patients with ACEi and between 9.8 and 14 cases/100,000 patients with ARBs were reported in more recent analyses [2]. Importantly, one cannot exclude the possibility that the true incidence may be higher because physicians do not always recognize the entity.…”