Review article: Risk of cardiovascular events in patients with inflammatory bowel disease receiving small molecule drugs

Summary Background In the context of an ageing inflammatory bowel disease (IBD) population, cardiovascular comorbidities become particularly relevant. Novel small molecule drugs (SMDs) for the treatment of moderate‐to‐severe IBD have been recently approved, including Janus kinase (JAK) inhibitors an...

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Published inAlimentary pharmacology & therapeutics Vol. 57; no. 11; pp. 1231 - 1248
Main Authors Olivera, Pablo A., Lasa, Juan S., Peretto, Giovanni, Zuily, Stephane, Danese, Silvio, Peyrin‐Biroulet, Laurent
Format Journal Article
LanguageEnglish
Published England Wiley Subscription Services, Inc 01.06.2023
Subjects
Arthritis, Rheumatoid - drug therapy
Bradycardia
Bradycardia - drug therapy
Cardiac arrhythmia
Cardiovascular diseases
Comorbidity
Conduction
Drug dosages
Humans
Immunosuppressive agents
Inflammatory bowel disease
Inflammatory bowel diseases
Inflammatory Bowel Diseases - complications
Inflammatory Bowel Diseases - drug therapy
Intestine
Janus kinase
Janus Kinase Inhibitors - therapeutic use
Pyrroles - adverse effects
Rheumatoid arthritis
Risk factors
Online AccessGet full text
ISSN0269-2813
1365-2036
1365-2036
DOI10.1111/apt.17509

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Abstract Summary Background In the context of an ageing inflammatory bowel disease (IBD) population, cardiovascular comorbidities become particularly relevant. Novel small molecule drugs (SMDs) for the treatment of moderate‐to‐severe IBD have been recently approved, including Janus kinase (JAK) inhibitors and sphingosine‐1‐phosphate receptor (S1P) modulators. Data from rheumatoid arthritis population have raised concerns about the risk of cardiovascular events with the use of tofacitinib, which was extrapolated to other immune‐mediated diseases and other JAK inhibitors. S1P receptor modulation has been associated with potential cardiovascular events, especially bradycardia and cardiac conduction abnormalities. Aim To review the incidence of cardiovascular events with the use of SMDs in patients with IBD and to provide practical recommendations on mitigation strategies. Methods Published literature was reviewed; recommendations were synthesised by experts in both cardiovascular diseases and IBD. Results Evidence from the IBD population does not indicate a higher risk of cardiovascular events with tofacitinib and other JAK inhibitors. The risk is higher in patients with intermediate to high cardiovascular risk. S1P modulators may be associated with a dose‐dependent, first‐dose effect, transient risk of conduction abnormalities (bradycardia and AV block). Screening and monitoring of cardiovascular risk factors should be done in all patients with IBD. Risk stratification for cardiovascular disease should be performed before starting treatment with SMDs. Conclusions Available evidence of both JAK inhibitors and S1P modulators indicates a reassuring safety profile of SMDs from the cardiovascular perspective in the overall IBD population. Efforts should be made to identify patients with IBD at a higher risk of cardiovascular events.
AbstractList In the context of an ageing inflammatory bowel disease (IBD) population, cardiovascular comorbidities become particularly relevant. Novel small molecule drugs (SMDs) for the treatment of moderate-to-severe IBD have been recently approved, including Janus kinase (JAK) inhibitors and sphingosine-1-phosphate receptor (S1P) modulators. Data from rheumatoid arthritis population have raised concerns about the risk of cardiovascular events with the use of tofacitinib, which was extrapolated to other immune-mediated diseases and other JAK inhibitors. S1P receptor modulation has been associated with potential cardiovascular events, especially bradycardia and cardiac conduction abnormalities.BACKGROUNDIn the context of an ageing inflammatory bowel disease (IBD) population, cardiovascular comorbidities become particularly relevant. Novel small molecule drugs (SMDs) for the treatment of moderate-to-severe IBD have been recently approved, including Janus kinase (JAK) inhibitors and sphingosine-1-phosphate receptor (S1P) modulators. Data from rheumatoid arthritis population have raised concerns about the risk of cardiovascular events with the use of tofacitinib, which was extrapolated to other immune-mediated diseases and other JAK inhibitors. S1P receptor modulation has been associated with potential cardiovascular events, especially bradycardia and cardiac conduction abnormalities.To review the incidence of cardiovascular events with the use of SMDs in patients with IBD and to provide practical recommendations on mitigation strategies.AIMTo review the incidence of cardiovascular events with the use of SMDs in patients with IBD and to provide practical recommendations on mitigation strategies.Published literature was reviewed; recommendations were synthesised by experts in both cardiovascular diseases and IBD.METHODSPublished literature was reviewed; recommendations were synthesised by experts in both cardiovascular diseases and IBD.Evidence from the IBD population does not indicate a higher risk of cardiovascular events with tofacitinib and other JAK inhibitors. The risk is higher in patients with intermediate to high cardiovascular risk. S1P modulators may be associated with a dose-dependent, first-dose effect, transient risk of conduction abnormalities (bradycardia and AV block). Screening and monitoring of cardiovascular risk factors should be done in all patients with IBD. Risk stratification for cardiovascular disease should be performed before starting treatment with SMDs.RESULTSEvidence from the IBD population does not indicate a higher risk of cardiovascular events with tofacitinib and other JAK inhibitors. The risk is higher in patients with intermediate to high cardiovascular risk. S1P modulators may be associated with a dose-dependent, first-dose effect, transient risk of conduction abnormalities (bradycardia and AV block). Screening and monitoring of cardiovascular risk factors should be done in all patients with IBD. Risk stratification for cardiovascular disease should be performed before starting treatment with SMDs.Available evidence of both JAK inhibitors and S1P modulators indicates a reassuring safety profile of SMDs from the cardiovascular perspective in the overall IBD population. Efforts should be made to identify patients with IBD at a higher risk of cardiovascular events.CONCLUSIONSAvailable evidence of both JAK inhibitors and S1P modulators indicates a reassuring safety profile of SMDs from the cardiovascular perspective in the overall IBD population. Efforts should be made to identify patients with IBD at a higher risk of cardiovascular events.
BackgroundIn the context of an ageing inflammatory bowel disease (IBD) population, cardiovascular comorbidities become particularly relevant. Novel small molecule drugs (SMDs) for the treatment of moderate‐to‐severe IBD have been recently approved, including Janus kinase (JAK) inhibitors and sphingosine‐1‐phosphate receptor (S1P) modulators. Data from rheumatoid arthritis population have raised concerns about the risk of cardiovascular events with the use of tofacitinib, which was extrapolated to other immune‐mediated diseases and other JAK inhibitors. S1P receptor modulation has been associated with potential cardiovascular events, especially bradycardia and cardiac conduction abnormalities.AimTo review the incidence of cardiovascular events with the use of SMDs in patients with IBD and to provide practical recommendations on mitigation strategies.MethodsPublished literature was reviewed; recommendations were synthesised by experts in both cardiovascular diseases and IBD.ResultsEvidence from the IBD population does not indicate a higher risk of cardiovascular events with tofacitinib and other JAK inhibitors. The risk is higher in patients with intermediate to high cardiovascular risk. S1P modulators may be associated with a dose‐dependent, first‐dose effect, transient risk of conduction abnormalities (bradycardia and AV block). Screening and monitoring of cardiovascular risk factors should be done in all patients with IBD. Risk stratification for cardiovascular disease should be performed before starting treatment with SMDs.ConclusionsAvailable evidence of both JAK inhibitors and S1P modulators indicates a reassuring safety profile of SMDs from the cardiovascular perspective in the overall IBD population. Efforts should be made to identify patients with IBD at a higher risk of cardiovascular events.
In the context of an ageing inflammatory bowel disease (IBD) population, cardiovascular comorbidities become particularly relevant. Novel small molecule drugs (SMDs) for the treatment of moderate-to-severe IBD have been recently approved, including Janus kinase (JAK) inhibitors and sphingosine-1-phosphate receptor (S1P) modulators. Data from rheumatoid arthritis population have raised concerns about the risk of cardiovascular events with the use of tofacitinib, which was extrapolated to other immune-mediated diseases and other JAK inhibitors. S1P receptor modulation has been associated with potential cardiovascular events, especially bradycardia and cardiac conduction abnormalities. To review the incidence of cardiovascular events with the use of SMDs in patients with IBD and to provide practical recommendations on mitigation strategies. Published literature was reviewed; recommendations were synthesised by experts in both cardiovascular diseases and IBD. Evidence from the IBD population does not indicate a higher risk of cardiovascular events with tofacitinib and other JAK inhibitors. The risk is higher in patients with intermediate to high cardiovascular risk. S1P modulators may be associated with a dose-dependent, first-dose effect, transient risk of conduction abnormalities (bradycardia and AV block). Screening and monitoring of cardiovascular risk factors should be done in all patients with IBD. Risk stratification for cardiovascular disease should be performed before starting treatment with SMDs. Available evidence of both JAK inhibitors and S1P modulators indicates a reassuring safety profile of SMDs from the cardiovascular perspective in the overall IBD population. Efforts should be made to identify patients with IBD at a higher risk of cardiovascular events.
Summary Background In the context of an ageing inflammatory bowel disease (IBD) population, cardiovascular comorbidities become particularly relevant. Novel small molecule drugs (SMDs) for the treatment of moderate‐to‐severe IBD have been recently approved, including Janus kinase (JAK) inhibitors and sphingosine‐1‐phosphate receptor (S1P) modulators. Data from rheumatoid arthritis population have raised concerns about the risk of cardiovascular events with the use of tofacitinib, which was extrapolated to other immune‐mediated diseases and other JAK inhibitors. S1P receptor modulation has been associated with potential cardiovascular events, especially bradycardia and cardiac conduction abnormalities. Aim To review the incidence of cardiovascular events with the use of SMDs in patients with IBD and to provide practical recommendations on mitigation strategies. Methods Published literature was reviewed; recommendations were synthesised by experts in both cardiovascular diseases and IBD. Results Evidence from the IBD population does not indicate a higher risk of cardiovascular events with tofacitinib and other JAK inhibitors. The risk is higher in patients with intermediate to high cardiovascular risk. S1P modulators may be associated with a dose‐dependent, first‐dose effect, transient risk of conduction abnormalities (bradycardia and AV block). Screening and monitoring of cardiovascular risk factors should be done in all patients with IBD. Risk stratification for cardiovascular disease should be performed before starting treatment with SMDs. Conclusions Available evidence of both JAK inhibitors and S1P modulators indicates a reassuring safety profile of SMDs from the cardiovascular perspective in the overall IBD population. Efforts should be made to identify patients with IBD at a higher risk of cardiovascular events.
Author Peretto, Giovanni
Peyrin‐Biroulet, Laurent
Danese, Silvio
Olivera, Pablo A.
Zuily, Stephane
Lasa, Juan S.
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  fullname: Lasa, Juan S.
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  fullname: Peretto, Giovanni
  organization: Vita‐Salute San Raffaele University
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  surname: Zuily
  fullname: Zuily, Stephane
  organization: Université de Lorraine, INSERM, DCAC and CHRU‐Nancy
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  givenname: Silvio
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  surname: Danese
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  surname: Peyrin‐Biroulet
  fullname: Peyrin‐Biroulet, Laurent
  email: peyrinbiroulet@gmail.com
  organization: Nancy University Hospital, Lorraine University
BackLink https://www.ncbi.nlm.nih.gov/pubmed/37038269$$D View this record in MEDLINE/PubMed
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Notes The Handling Editor for this article was Professor Cynthia Seow, and this uncommissioned review was accepted for publication after full peer‐review.
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PublicationTitle Alimentary pharmacology & therapeutics
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Snippet Summary Background In the context of an ageing inflammatory bowel disease (IBD) population, cardiovascular comorbidities become particularly relevant. Novel...
In the context of an ageing inflammatory bowel disease (IBD) population, cardiovascular comorbidities become particularly relevant. Novel small molecule drugs...
BackgroundIn the context of an ageing inflammatory bowel disease (IBD) population, cardiovascular comorbidities become particularly relevant. Novel small...
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SubjectTerms Arthritis, Rheumatoid - drug therapy
Bradycardia
Bradycardia - drug therapy
Cardiac arrhythmia
Cardiovascular diseases
Comorbidity
Conduction
Drug dosages
Humans
Immunosuppressive agents
Inflammatory bowel disease
Inflammatory bowel diseases
Inflammatory Bowel Diseases - complications
Inflammatory Bowel Diseases - drug therapy
Intestine
Janus kinase
Janus Kinase Inhibitors - therapeutic use
Pyrroles - adverse effects
Rheumatoid arthritis
Risk factors
Title Review article: Risk of cardiovascular events in patients with inflammatory bowel disease receiving small molecule drugs
URI https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fapt.17509
https://www.ncbi.nlm.nih.gov/pubmed/37038269
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https://www.proquest.com/docview/2799825339
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