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Konstantinos Karmiris, Peter Bossuyt, Dario Sorrentino, Tom Moreels, Antonella Scarcelli, Jesus Legido, Iris Dotan, Graham D. Naismith, Airi Jussila, Jan C. Preiss, Wolfgang Kruis, Andy C. Y. Li, Guillaume Bouguen, Henit Yanai, Flavio Steinwurz, Konstantinos H. Katsanos, Kavitha Subramaniam, Dino Tarabar, Ioannis V. Zaganas, Shomron Ben-Horin, ECCO CONFER investigators, Cerebrovascular events in inflammatory bowel disease patients treated with anti-tumour necrosis factor alpha agents, Journal of Crohn's and Colitis, Volume 9, Issue 5, May 2015, Pages 382–389, https://doi.org/10.1093/ecco-jcc/jjv042
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Abstract
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.
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.
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].
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.
