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J Crohns Colitis. 2015 May;9(5):382-9. doi: 10.1093/ecco-jcc/jjv042. Epub 2015 Mar 4.

Cerebrovascular events in inflammatory bowel disease patients treated with anti-tumour necrosis factor alpha agents.

Author information

1
Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece kkarmiris@gmail.com.
2
Imelda GI Clinical Research Center, Bonheiden, Belgium.
3
IBD Center, Virginia Tech-Carilion School of Medicine, Roanoke, VA, USA and Department of Clinical and Experimental Medical Sciences, University of Udine School of Medicine, Udine, Italy.
4
Department of Hepato-gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
5
Department of Gastroenterology, Azienda University Hospital, Policlinico di Modena, Italy.
6
Gastroenterology Unit, Segovia General Hospital, Segovia, Spain.
7
IBD Center, Department of Gastroenterology and Liver Diseases and the Sackler School of Medicine, Sourasky Medical Center, Tel Aviv, Israel.
8
Department of Gastroenterology, Paisley RAH, Glasgow, Scotland.
9
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
10
Charité-Universitätsmedizin, Berlin, Germany.
11
Department of Gastroenterology, Western Sussex Hospitals NHSFT, Worthing, UK.
12
Department of Gastroenterology, University Hospital Pontchaillou, Rennes, France.
13
IBD Unit, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
14
Division of Gastroenterology, University Hospital of Ioannina, Greece.
15
Gastroenterology and Hepatology Unit, Canberra Hospital, Canberra, Australia.
16
Department of Gastroenterology, MMA Belgrade, Serbia.
17
Department of Neurology, University Hospital of Heraklion, Heraklion, Crete, Greece.
18
Department of Gastroenterology, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel.

Abstract

BACKGROUND AND AIMS:

Cerebrovascular accidents [CVA] have rarely been reported in inflammatory bowel disease [IBD] patients treated with anti-tumour necrosis alpha [anti-TNF alpha] agents. Our aim here was to describe the clinical course of CVA in these patients.

METHODS:

This was a European Crohn's and Colitis Organisation [ECCO] retrospective observational study, performed as part of the CONFER [COllaborative Network For Exceptionally Rare case reports] project. A call to all ECCO members was made to report on IBD patients afflicted with CVA during treatment with anti-TNF alpha agents. Clinical data were recorded in a standardised case report form and analysed for event association with anti-TNF alpha treatment.

RESULTS:

A total of 19 patients were identified from 16 centres: 14 had Crohn's disease, four ulcerative colitis and one IBD colitis unclassified [median age at diagnosis: 38.0 years, range: 18.6-62.5]. Patients received anti-TNF alpha for a median duration of 11.8 months [range: 0-62] at CVA onset; seven had previously been treated with at least one other anti-TNF alpha agent. Complete neurological recovery was observed in 16 patients. Anti-TNF alpha was discontinued in 16/19 patients. However, recurrent CVA or neurological deterioration was not observed in any of the 11 patients who received anti-TNF alpha after CVA [eight resumed after temporary cessation, three continued without interruption] for a median follow-up of 39.8 months [range: 5.6-98.2].

CONCLUSION:

These preliminary findings do not unequivocally indicate a causal role of anti-TNF alpha in CVA complicating IBD. Resuming or continuing anti-TNF alpha in IBD patients with CVA may be feasible and safe in selected cases, but careful weighing of IBD activity versus neurological status is prudent.

KEYWORDS:

Cerebrovascular accidents; anti-TNF alpha agents; inflammatory bowel disease

PMID:
25740813
DOI:
10.1093/ecco-jcc/jjv042
[Indexed for MEDLINE]

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