Risk of neutropenia in inflammatory bowel disease patients treated with TNF inhibitors: A single-center, retrospective cohort study

Abstract

Background/Aim: Tumor necrosis factor inhibitors (TNFi) have become the mainstay of treatment in moderate-to-severe cases of inflammatory bowel disease (IBD). Neutropenia has been reported in patients receiving TNFi for IBD and other diseases. In this study, we aimed to ascertain the relationship between the use of TNFi and the development of neutropenia in patients with IBD. Patients and Methods: This is a retrospective cohort study including all adult patients with IBD receiving TNFi at a tertiary care center over an 11-year period. The primary outcome was the development of any neutropenic episode after starting a TNFi. For our secondary outcomes, we evaluated the impact of concomitant use of 5-aminosalicylic acid (5-ASA) or an immunomodulator on the risk of developing neutropenia. Results: The final analysis included 281 patients. Of those included, 34.2% developed at least one episode of neutropenia while on a TNFi. The majority of these episodes (67.7%) were mild with ANC between 1000 and 1500/mm 3 . No significant difference was observed in the age, gender, agent used or type of IBD between those who developed neutropenia and those who did not. Concomitant use of azathioprine (OR = 2.32, 95% CI: 1.26–4.28; P = 0.007) or 5-ASA (OR = 3.15, 95% CI: 1.55–6.39; P = 0.001) were significant independent predictors of developing neutropenia. Conclusions: In this study, mild neutropenia was common among patients with IBD on TNFi. Future prospective studies are required to further clarify the significance of neutropenia in patients with IBD receiving TNFi.

Monitoring for 5-aminosalicylate toxicity: prognostic model development and validation

“…Nevertheless, these are plausible predictors. Co-prescription of a thiopurine was a strong risk-factor for toxicity consistent with other studies 38–40 . Abnormal blood-test results during the first six months of therapy were strong independent predictors of discontinuing 5-ASA with abnormal monitoring blood-test results, like previous reports about other drugs 23,41 .…”

Prognostic factors for liver, blood and kidney adverse events from glucocorticoid sparing immune-suppressing drugs in immune-mediated inflammatory diseases: a prognostic systematic review

“…Anti-TNFs were evaluated in 10 studies 63–72 in patients with either RA, AS, PsO or PsA, 64 65 67 69 AS only, 66 2 in PsA only 68 72 and 3 in IBD. 63 70 71 Of the 10 studies, 1 used an RCT design, 68 1 a prospective cohort design 72 and the remaining were retrospective cohort studies.…”

A Methodological Review of Drug-Related Toxicological Studies in Saudi Arabia

“…All 30 articles included in this systematic review were observational studies (seven cohort studies and 23 cross-sectional studies). Of the 30 studies, 26 (86.66%) obtained their data from an administrative database and/or patient interviewing [3,[14][15][16][17][18][21][22][23][24]26,[28][29][30][31][32][34][35][36][37][38][39][40][41], two studies (6.66%) from a survey [33,42], and two studies (6.66%) did not specify the data source [19,27]. Most of the studies reported the outcomes over a short period.…”

“…All articles were written in English and conducted in Saudi Arabia. Thirteen studies were from the Riyadh region [3,[14][15][16][17][18][19][20][21][22][23][24][25], nine were from the Makkah region [26][27][28][29][30][31][32][33][34], three studies were from the Eastern region [35][36][37], three studies were from the Qassim region [38][39][40], one study was from the Najran region [41], and one study covered entire Saudi Arabia [42]. In relation to the range of years of publication, the oldest article was from 2012, and the latest was from 2021.…”

“…Most studies included both men and women, except two studies that included only women. Out of 30 studies, four studies were aimed to explore drug-related hospitalizations [ 3 , 32 , 35 , 38 ], eight studies explored the adverse drug reactions [ 14 , 15 , 17 , 21 , 33 , 37 , 40 , 42 ], three studies explored drug-induced cardiotoxicity [ 16 , 24 , 27 ], four studies explored drug-induced nephrotoxicity [ 19 , 23 , 30 , 31 ], one study explored drug-induced pulmonary toxicity [ 26 ], one study explored drug-induced retinal toxicity [ 20 ], eight studies explored poisoning [ 18 , 22 , 25 , 28 , 29 , 34 , 39 , 41 ], and one study explored drug overdose [ 36 ]. Full details about the included studies are available in Table 1 .…”