The following is a summary of the “Inflammatory Bowel Disease Risk in Patients With Axial Spondyloarthritis Treated With Biologic Agents Determined Using the BSRBR-AS and a MetaAnalysis,” published in the February 2023 issue of Rheumatology by Macfarlane, et al.
To compare the risk of inflammatory bowel disease (IBD) between patients with axial spondyloarthritis (axSpA) treated with biologic therapies and those treated with other therapies, and to see if the risk is higher in patients treated with etanercept (ETN).
The incidence of inflammatory bowel disease (IBD) during follow-up was determined using data from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS), and the incidence rate difference (IRD) per 1,000 person-years (PY) between biologic treatment and other treatment groups was calculated.
Then, they performed a meta-analysis to calculate the absolute difference in IBD incidence between the treatment groups by conducting a systematic review that included both observational studies and RCTs. According to the BSRBR-AS, the incidence of IBD was higher among people with axSpA who had been exposed to biologic therapy than among those who had not (IRD 11.9, 95% CI 4.3-19.6). Observational studies also found this, but randomized controlled trials without a placebo did not (IRD 2.2, 95% CI 4.1 to 8.5). The BSRBR-AS data do not indicate an increased risk of IBD among those exposed to ETN compared to those not (IRD 6.5, 95% CI 21.3 to 8.5).
Evidence from randomized controlled trials (RCTs) and meta-analyses of these studies suggest an absolute increase in the incidence of ETN of between 2.1 and 5.8 per 1,000 PY compared to another anti-tumor necrosis factor (TNF) therapies; however, this difference is not statistically significant.
In observational studies, patients who were given biologics had a higher risk of developing inflammatory bowel disease. Only randomized controlled trials (RCTs) indicated that ETN posed a higher risk than alternative anti-TNF therapies, though a great deal of uncertainty surrounded this conclusion.
Source: jrheum.org/content/50/2/175
