The impact of co‐existing immune‐mediated diseases on phenotype and outcomes in inflammatory bowel diseases

• Published in: Alimentary pharmacology & therapeutics 2017-03, Vol.45 (6), p.814-823
• Main Authors: Conway, G., Velonias, G., Andrews, E., Garber, J. J., Yajnik, V., Ananthakrishnan, A. N.
• Format: Article
• Language: English
• Subjects: Adult; Bowel disease; Colitis, Ulcerative - diagnosis; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - epidemiology; Comorbidity; Crohn Disease - diagnosis; Crohn Disease - drug therapy; Crohn Disease - epidemiology; Demographics; Demography; Female; Genotype & phenotype; Humans; Immune System Diseases - diagnosis; Immune System Diseases - drug therapy; Immune System Diseases - epidemiology; Immunologic Factors - pharmacology; Immunologic Factors - therapeutic use; Inflammatory bowel diseases; Inflammatory Bowel Diseases - diagnosis; Inflammatory Bowel Diseases - drug therapy; Inflammatory Bowel Diseases - epidemiology; Intestine; Male; Middle Aged; Phenotype; Prospective Studies; Quality of Life; Registries; Regression analysis; Surgery; Treatment Outcome; Tumor necrosis factor; Tumor Necrosis Factor-alpha - antagonists & inhibitors
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.13940

Summary Background Inflammatory bowel diseases lead to progressive bowel damage and need for surgery. While the increase in prevalence of other immune‐mediated diseases in IBD is well recognised, the impact of this on the natural history of IBD is unknown. Aim To determine the impact of concomitant immune‐mediated diseases on phenotypes and outcomes in IBD. Methods Patients with IBD enrolled in a prospective registry were queried about the presence of other immune‐mediated diseases, defined as those where immune dysregulation plays a role in pathogenesis. Demographics and disease‐related information were obtained. Subjects also completed measures of quality of life. Multivariable regression models compared disease phenotype and outcomes of IBD patients with and without other immune‐mediated diseases. Results The cohort included 2145 IBD patients among whom 458 (21%) had another immune‐mediated disease. There was no difference in CD phenotype between the two groups. UC patients were more likely to have pancolitis in the presence of another immune‐mediated disease (62%) compared to those without (52%, P = 0.02). IBD patients with another immune‐mediated disease had higher rates of needing anti‐TNF biologics [Odds ratio (OR) 1.31, 95% CI 1.05–1.63] and surgery (OR 1.26, 95% CI 0.99–1.61). The presence of another immune‐mediated disease was also associated with lower disease‐specific and general physical quality of life. Conclusions The presence of another immune‐mediated disease in IBD patients was associated with higher likelihood of pancolonic involvement in UC, and a modest increase in need for IBD‐related surgery and anti‐TNF biological therapy. Such patients also experienced worse quality of life. Linked ContentThis article is linked to Vegh et al and Ananthakrishnan papers. To view these articles visit https://doi.org/10.1111/apt.13987 and https://doi.org/10.1111/apt.13998.