Increased risk of acute arterial events in young patients and severely active IBD: a nationwide French cohort study

Kirchgesner, Julien; Beaugerie, Laurent; Carrat, Fabrice; Andersen, Nynne Nyboe; Jess, Tine; Schwarzinger, Michaël

doi:10.1136/gutjnl-2017-314015

Cited by 116 publications

(135 citation statements)

References 40 publications

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“…The present study was based on data from the French national hospital discharge database. The latter contains a large number of cases of CD (n = 129 089, ensuring high‐statistical power), and has already been analysed in epidemiological studies of IBD . With regard to CD, the discharge data were cross‐validated against the cumulative incidence found in the EPIMAD registry.…”

Section: Discussionmentioning

confidence: 99%

“…Patients having at least one in‐patient stay for CD between 1 January 2007 and 31 December 2014 were considered for eligibility in this study. Inpatient stays with CD were identified by searching the database with the following ICD‐10 diagnostic codes: K50.0, K50.1, K50.8 or K50.9 (“Crohn's disease [regional enteritis]”) . When patients had an ulcerative colitis (UC) code (K51*) during one in‐patient stay and a CD code during another, only individuals with a CD code during the last in‐patient stay (in our study period) were considered.…”

Section: Methodsmentioning

confidence: 99%

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Fine‐scale geographical distribution and ecological risk factors for Crohn's disease in France (2007‐2014)

Génin

Fuméry

Occelli

et al. 2019

Aliment Pharmacol Ther

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Summary Background Geographical variations in Crohn's disease (CD) suggest that the environment has a role in the pathogenesis of this condition. Aims To describe the spatial distribution and the clustering of CD cases in France, and to assess the relationship between the prevalence of CD and environmental risk factors. Methods We identified all patients with CD included in the French hospital discharge database from 2007 to 2014. Age‐ and gender‐smoothed standardised prevalence ratios over this period were computed for 5610 spatial units. An ecological regression analysis was used to assess the relationship between the risk of CD and ecological variables (health care, latitude, socio‐economic deprivation, urbanisation, proportion of agricultural surfaces and density of industries). Local spatial clusters of high‐CD prevalence were searched for using elliptic spatial scan statistics and characterised in a hierarchical ascendant classification based on the same ecological variables. Results About 129 089 patients with CD were identified, yielding a crude prevalence of 203 per 100 000 inhabitants. The overall spatial heterogeneity was statistically significant (P < .001). An elevated risk of CD was found to be significantly associated with high‐social deprivation (relative risk [95% confidence interval] = 1.05 [1.02‐1.08]) and high urbanisation (1.09 [1.04‐1.14]). Sixteen significant spatial clusters of high‐CD prevalence were identified; there were no common ecological variables. Conclusions The geographical distribution of CD prevalence in France is not uniform, and is associated with high levels of social deprivation and urbanisation. Larger ecological databases integrating more detailed environmental and clinical information are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Fine‐scale geographical distribution and ecological risk factors for Crohn's disease in France (2007‐2014)

Génin

Fuméry

Occelli

et al. 2019

Aliment Pharmacol Ther

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“…However, the association between chronic systemic inflammation and the risk of acute arterial events remains unclear in patients with IBD. Two studies based on medico-administrative databases concluded that IBD disease activity was an independent predictor of acute arterial events [5,6]. However, the disease activity was assessed trough indirect markers, including hospitalizations, surgical procedures, and treatment exposure [6,9].…”

Section: Introductionmentioning

confidence: 99%

Clinical activity is an independent risk factor of ischemic heart and cerebrovascular arterial disease in patients with inflammatory bowel disease

et al. 2018

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Background and aimsIn inflammatory bowel disease (IBD), the impact of established cardiovascular risk factors and disease-related factors on the risk of acute arterial events is still unclear. We aimed to identify risk factors of acute arterial events in patients with IBD.MethodsAll consecutive patients followed at Saint-Antoine Hospital between 1996 and 2015 with subsequent occurrence of acute arterial events (acute coronary syndrome or ischemic stroke) were identified. Traditional cardiovascular risk factors, treatment exposure, systemic inflammation (mean serum CRP level greater than or equal to 5 mg/L) and IBD clinical activity were assessed. A nested case-control study was performed including cases and controls without arterial ischemic event, matched on age, gender, and disease extent.ResultsA total of 30 patients (median age at acute vascular event occurrence: 42 years (interquartile range: 25–59)) developed acute coronary syndrome (n = 22) or ischemic stroke (n = 8). In univariate analysis, clinical disease activity and the persistence of systemic inflammation, diabetes, dyslipidemia and hypertension were significantly associated with an increased risk of acute arterial events. Neither protective nor aggravating effects associated with treatment exposure were identified. In multivariate analysis, the presence of diabetes (Odds ratio (OR): 14.5, 95% confidence interval (CI): 1.1–184.7) and clinical disease activity (OR: 10.4, 95% CI: 2.1–49.9) remained significantly associated with the risk of acute arterial event.ConclusionDisease activity may have an independent impact on the risk of acute arterial events in patients with IBD. These findings may highlight new potential benefits of optimizing anti-inflammatory treatment in patients with persisting clinical activity.

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“…Second, an algorithm was used to identify UC patients. Other studies have used the same algorithm, based on the combination of hospitalisation and long‐term diseases UC codes. The present study also used dispensing of infliximab (excluding other indications for anti‐TNF therapy).…”

Section: Discussionmentioning

confidence: 99%

The effectiveness and safety of infliximab compared with biosimilar CT‐P13, in 3112 patients with ulcerative colitis

Meyer

Rudant

Drouin

et al. 2019

Aliment Pharmacol Ther

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Summary Background CT‐P13, a biosimilar of the reference product infliximab, has been approved for the treatment of ulcerative colitis on the basis of the results of trials conducted in patients with spondyloarthritis and rheumatoid arthritis. Aim To compare the effectiveness and safety of CT‐P13 and the reference product in infliximab‐naive patients with ulcerative colitis Methods A comparative real‐life equivalence cohort study was conducted using the French nationwide health administrative database. Infliximab‐naive patients with ulcerative colitis over 15 years of age who started infliximab with no other indications for infliximab were included. The primary outcome was a composite endpoint (death, ulcerative colitis‐related surgery, all‐cause hospitalisation and reimbursement for other biologics). Equivalence was defined as a 95% CI of the hazard ratio (HR) of CT‐P13 vs the reference product, in a multivariable marginal Cox model situated within prespecified margins of (0.80‐1.25). Results A total of 3112 patients were included between 1 January 2015 and 30 June 2017: 1434 received the reference product, 1678 received CT‐P13. Overall, 710 patients in the reference product group and 743 patients in the CT‐P13 group met the composite endpoint. In multivariable analysis of the primary outcome, CT‐P13 was equivalent to the reference product (HR 1.04; 95% CI: 0.94‐1.15). The number of serious infections was lower in the CT‐P13 group (HR 0.65; 95% CI: 0.48‐0.88). There was no difference in the incidence of solid or haematologic malignancy (HR 0.81; 95% CI: 0.41‐1.60). Conclusions The effectiveness of CT‐P13 is equivalent and the risk of serious infections could be lower than that of the reference product for infliximab‐naive patients with ulcerative colitis.

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Increased risk of acute arterial events in young patients and severely active IBD: a nationwide French cohort study

Abstract: Patients with IBD are at increased risk of acute arterial events, with the highest risk in young patients. Disease activity may also have an independent impact on the risk.

Cited by 116 publications

References 40 publications

Fine‐scale geographical distribution and ecological risk factors for Crohn's disease in France (2007‐2014)

Fine‐scale geographical distribution and ecological risk factors for Crohn's disease in France (2007‐2014)

Clinical activity is an independent risk factor of ischemic heart and cerebrovascular arterial disease in patients with inflammatory bowel disease

The effectiveness and safety of infliximab compared with biosimilar CT‐P13, in 3112 patients with ulcerative colitis

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