Abstract
Introduction: Preclinical data support the notion that activation of the renin-angiotensin system (RAS) contributes to the pathogenesis of inflammatory bowel disease (IBD), and inhibition of RAS by angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) protects against colitis in animal models. Less is known regarding clinical outcomes with use of these medications in IBD patients. In order to test the hypothesis that blockade of RAS improves intestinal inflammation, we compared clinical outcomes in ACEI or ARB treated individuals to matched untreated patients in a cohort of IBD patients from a single tertiary care center. Methods: We performed a retrospective cohort study using the IBD registry at the University of Chicago. ACEI or ARB users were compared to non-users matched 1:4 on the basis of sex, age +/- 5 years, diagnosis, and disease location. Data on clinical outcomes including rates of hospitalizations, operations, and corticosteroid use were collected in addition to comorbidities and medication use. Results: Sixty-five ACEI- or ARB-treated patients with a minimum of six months of follow up were included, 41 patients with Crohn's disease (CD) and 24 with ulcerative colitis (UC) with mean follow up of 2.3 years. The control group was comprised of 260 matched IBD patients with no history of ACEI or ARB exposure with mean follow up of 2.9 years. Mean age was 53 years in the ACEI/ARB group and 52 years in the control group. Thiopurine, anti-TNFα, and 5-ASA medications were similar between the two groups. Compared to control patients, CD patients taking ACEI or ARB had higher rates of hospitalizations per year (0.45 v. 0.21), similar numbers of operations per year (0.17 v. 0.16), and more corticosteroid prescriptions per year (0.70 v. 0.61). UC patients taking ACEI or ARB had more hospitalizations per year (0.35 v. 0.11), more operations per year (0.16 v. 0.08), and more corticosteroid prescriptions per year (1.22 v. 0.34) compared to control patients. ACEI use was also associated with increased hospitalization rates and operations compared to ARB use among IBD patients (0.45 v. 0.34 and 0.19 v. 0.14, respectively), but a lower number of corticosteroid prescriptions per year (0.68 v. 1.30). Conclusion: ACEI or ARB use in IBD patients was associated with more hospitalizations, operations, and corticosteroid use in our tertiary referral population. Prospective studies are needed to assess the causal role of RAS inhibition on disease activity.
Published Version
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