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Steroid Therapy Increases Risk of Blood Clots Five-Fold in IBD Patients

Study shows strong association for first time

Compared with biologic therapy, corticosteroid (steroid) use is associated with a nearly five-fold increase of venous thromboembolism in patients with inflammatory bowel disease (IBD), according to a new study published in Clinical Gastroenterology and Hepatology.

Venous thromboembolism is a condition that includes both deep vein thrombosis and pulmonary embolism.

“We found that corticosteroid use — either alone or in combination with biologics — substantially increases the rate of venous thromboembolic events,” said lead author Peter Higgins, MD, PhD, MSc, of the University of Michigan, Ann Arbor. “This was strikingly different from the patients who were on biologics alone, who had a significantly lower rate of events. Venous thromboembolism is common in IBD and can lead to significant morbidity, increased death, and high rates of recurrent blood clots. The importance of understanding what causes this complication in this patient group cannot be understated.”

In a retrospective analysis, researchers monitored 15,100 patients treated with biologics, corticosteroids, or combination therapy (biologics and corticosteroids) for venous thromboembolic events over a 12-month follow-up period. A total of 325 venous thromboembolic events occurred during that time. The rates were 2.25%, 0.44%, and 2.49% for the patients treated with a corticosteroid only, a biologic only, or combination therapy, respectively.

“Combination therapy with corticosteroids and biologics was associated with nearly the same risk as corticosteroids alone, validating our conclusion that corticosteroids may truly increase venous thromboembolism risk and eliminate the potential benefit [for venous thromboembolic events] of inducing remission with biologics alone,” Higgins added.

While the association between active IBD flares and venous thromboembolism has been well established, the new study shows for the first time a strong independent association between corticosteroid use and venous thromboembolism. A better understanding of the effects of corticosteroids on this complication of IBD may suggest a change in the current therapeutic approach to severe inflammation in IBD, according to the authors.

Corticosteroids are often prescribed to IBD patients to reduce inflammation. These drugs have a structure similar to that of estrogens, which are also associated with increased venous thromboembolism events.

The new study was funded by AbbVie Inc.

Source: AGA; January 29, 2015.

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