Cerebrovascular events in inflammatory bowel disease patients treated with anti-tumour necrosis factor alpha agents

Background and aims: Cerebrovascular accidents [CVA] have rarely been reported in inflammatory bowel disease [IBD] patients treated with anti-tumour necrosis alpha [anti-TNF alpha] agents. Our aim here was to describe the clinical course of CVA in these patients. Methods: This was a European Crohn’s...

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Veröffentlicht in:Journal of Crohn's and colitis 2015-05, Vol.9 (5), p.382-389
Hauptverfasser: Karmiris, Konstantinos, Bossuyt, Peter, Sorrentino, Dario, Moreels, Tom, Scarcelli, Antonella, Legido, Jesus, Dotan, Iris, Naismith, Graham D., Jussila, Airi, Preiss, Jan C., Kruis, Wolfgang, Li, Andy C. Y., Bouguen, Guillaume, Yanai, Henit, Steinwurz, Flavio, Katsanos, Konstantinos H., Subramaniam, Kavitha, Tarabar, Dino, Zaganas, Ioannis V., Ben-Horin, Shomron
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Sprache:eng
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Zusammenfassung:Background and aims: Cerebrovascular accidents [CVA] have rarely been reported in inflammatory bowel disease [IBD] patients treated with anti-tumour necrosis alpha [anti-TNF alpha] agents. Our aim here was to describe the clinical course of CVA in these patients. Methods: This was a European Crohn’s and Colitis Organisation [ECCO] retrospective observational study, performed as part of the CONFER [COllaborative Network For Exceptionally Rare case reports] project. A call to all ECCO members was made to report on IBD patients afflicted with CVA during treatment with anti-TNF alpha agents. Clinical data were recorded in a standardised case report form and analysed for event association with anti-TNF alpha treatment. Results: A total of 19 patients were identified from 16 centres: 14 had Crohn’s disease, four ulcerative colitis and one IBD colitis unclassified [median age at diagnosis: 38.0 years, range: 18.6–62.5]. Patients received anti-TNF alpha for a median duration of 11.8 months [range: 0–62] at CVA onset; seven had previously been treated with at least one other anti-TNF alpha agent. Complete neurological recovery was observed in 16 patients. Anti-TNF alpha was discontinued in 16/19 patients. However, recurrent CVA or neurological deterioration was not observed in any of the 11 patients who received anti-TNF alpha after CVA [eight resumed after temporary cessation, three continued without interruption] for a median follow-up of 39.8 months [range: 5.6–98.2]. Conclusion: These preliminary findings do not unequivocally indicate a causal role of anti-TNF alpha in CVA complicating IBD. Resuming or continuing anti-TNF alpha in IBD patients with CVA may be feasible and safe in selected cases, but careful weighing of IBD activity versus neurological status is prudent.
ISSN:1873-9946
1876-4479
DOI:10.1093/ecco-jcc/jjv042