A recent study from the University of Michigan led by Peter Higgins, found that compared with biologic therapy, corticosteroid therapy increases the risk in five-fold of venous thromboembolism in patients with inflammatory bowel disease.
Evidence has established a strong association between inflammatory bowel disease (IBD) flares and the risk of venous thromboembolism (VTE) and pulmonary embolism.
In their study entitled “Increased Risk of Venous Thromboembolic Events With Corticosteroid vs Biologic Therapy for Inflammatory Bowel Disease” published in the current issue of the journal Clinical Gastroenterology and Hepatology, the research team retrospectively examined a total of 15,100 adults with inflammatory bowel disease for 12 months who were treated with biologics, corticosteroids or combination therapy, and examined the risk of venous thromboembolic events.
Using logistic regression to examine the effects of biologic, corticosteroid, and combination therapies (biologics and corticosteroids) on VTE risk, the researchers were able to identify during the study period, 325 cases of VTEs in 2.25% of the patients who received only corticosteroids, in 0.44% of the patients who received biologics, and in 2.49% of the patients who received the combination therapy.
Furthermore, the research team found that compared with the patients who received only corticosteroids, the likelihood for VTE in patients receiving only biologics was 0.2, and the likelihood for VTE in patients on combination therapy was 1.01.
“We found that corticosteroid use — either alone or in combination with biologics — substantially increases the rate of venous thromboembolic events,” said lead study author Peter D.R. Higgins, MD, PhD, MSc, from the University of Michigan, in a recent news release. “This was strikingly different from the patients who were on biologics alone, who had a significantly lower rate of events. Venous thromboembolism is common in IBD, and can lead to significant morbidity, increased death and high rates of recurrent blood clots. The importance of understanding what causes this complication in this patient group cannot be understated.”
Based on these results, the researchers found that compared with treatment biologic therapy alone, corticosteroid therapy is associated with a 5-fold increased risk of VTE occurrence. Since results showed that combination therapy with corticosteroids and biologic agents was associated with the same risk for VTE as that of corticosteroids alone, Higgins and colleagues indicate that corticosteroids seem to increase the risk for VTE occurrence. Thus, the effects of corticosteroids on this IBD associated complication should be of clinical concern and indicate the need of different treatments for patients with IBD.
Dr. Higgins concluded in the news release, “Combination therapy with corticosteroids and biologics was associated with nearly the same risk as corticosteroids alone, validating our conclusion that corticosteroids may truly increase venous thromboembolism risk, and eliminate the potential benefit (for venous thromboembolic events) of inducing remission with biologics alone.”