Associations Between Anti-TNFα Exposure and Autoimmune Disease in IBD Patients

Patients with inflammatory bowel disease (IBD) who were exposed to an anti-TNFα agent were at an increased risk of certain autoimmune diseases, according to recent research.

Investigators conducted a population-based case-control study to evaluate whether exposure to anti-TNF agents is associated with the subsequent development of autoimmune diseases in patients with IBD. Patients were identified using the Korean National Health Insurance Service (NHIS) database from 2004 through 2018.

IBD patients with diagnostic codes for autoimmune disease were matched to a control with IBD without the presence of an autoimmune disease based on age, sex, subtype and diagnosis year of IBD.

The study cohort included a total of 515,707 incident IBD patients, of which 45,430 cases of autoimmune disease were identified and 470,277 were unmatched controls. Of this, 68% were over the age of 40 and the median of IBD duration until diagnosis of autoimmune disease was 5.75 years.

Investigators found that the proportion of cases with overall autoimmune disease who received treatment with anti-TNFα agents was higher than that of controls. IBD patients who were exposed to anti-TNFα agents after IBD diagnosis had a 1.35 increased overall autoimmune disease risk. This elevated risk was maintained even after adjusting for multiple confounding factors.

Additionally, a logistic regression analysis revealed that the use of anti-TNF agents increased the risk of autoimmune disease, especially in psoriasis and lupus. A cumulative effect of anti-TNF agents was also confirmed.

“This study found that exposure to anti-TNFα in patients with IBD appeared to be associated with increased risk of autoimmune diseases particularly psoriasis and lupus,” the authors concluded. “It is presumed that inhibition of inflammatory cascade by anti-TNF agents induces other unexpected immune responses.”

Reference

1. Oh SJ, Kim HJ, Lee CK, et al. Exposure to Anti-tnfα Agent Increases The Development of Autoimmune Disease In Inflammatory Bowel Disease: A Population Based Case-Control Study. Presented at: Digestive Disease Week; May 6-9, 2023; Chicago, IL. Poster 1707.