Anti-TNF therapy is associated with lower mortality rates compared to prolonged corticosteroid use in patients with Crohn’s disease, researchers suggest.
This reduced mortality may be linked to lower rates of major cardiovascular events or hip fractures.
Also, the lower mortality rates seen in Crohn’s patients were more significant in those with multiple or serious comorbidities. A comorbidity is one or more diseases that are happening at the same time as the primary condition — in this case, Crohn’s disease.
As the authors suggest, these patients are often excluded from clinical trials, yet they might benefit the most from anti-TNF therapy.
“This population, which is rarely included in clinical trials and for whom some physicians may be reluctant to treat with chronic immunosuppression, may be particularly good candidates for anti-TNF agents as [corticosteroid-sparing] therapy,” they wrote.
The study, “Increased Mortality Rates With Prolonged Corticosteroid Therapy When Compared With Antitumor Necrosis Factor-α-Directed Therapy for Inflammatory Bowel Disease,” was recently published in the American Journal of Gastroenterology.
Inflammatory bowel disease (IBD) can include both Crohn’s disease and ulcerative colitis (UC). Two of the main treatments used to control IBD symptoms include corticosteroids and anti-tumor necrosis factor-α (anti-TNF) therapy.
Despite growing evidence that corticosteroids are not as effective as anti-TNF therapy, they are still widely prescribed. This may stem partly from concerns regarding the long-term side effects of anti-TNF therapy, including an increased risk of cancer.
Adverse events associated with corticosteroids include serious infections and congestive heart failure.
In this retrospective study, researchers used Medicaid and Medicare data to identify patients with a diagnosis of IBD and who were being treated with either prolonged corticosteroids or new anti-TNF therapy.
Among patients with Crohn’s disease, 7,694 were part of the prolonged corticosteroid users, and 1,879 Crohn’s patients were new anti-TNF users.
For ulcerative colitis patients, 3,224 were prolonged corticosteroid users and 459 were new anti-TNF users.
Between these groups, there were no significant differences in age, sex, race, and comorbidity score.
The researchers found that Crohn’s patients treated with anti-TNF therapy were 28% less likely to die from any cause compared to patients treated with corticosteroids.
Although there was an observed decrease in the risk of death in UC patients treated with anti-TNF therapy, this effect was not statistically significant.
Among Crohn’s patients, anti-TNF therapy was also associated with reduced rates of major cardiovascular events and hip fractures. The risk for other adverse events such as serious infection, cancer, and pulmonary embolus were not significantly different between the two treatment groups.